Registered Nurse Pre-Service Authorization

Essentia Health; Duluth (MN); Remote; USD 71,000 - 106,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

401(k) plan with employer contribution

Tuition reimbursement

Flexible scheduling

Job summary

Essentia Health in Duluth, MN is hiring for a Health Services professional to conduct Managed Care Programs in coordination with third party administrators. You will help implement referral, prior authorization, and precertification processes using Essentia Health policies.

The role requires nursing licensure and a BSN or ADN, with potential remote/hybrid work. You will collaborate with Access Coordinators, nursing teams, and Health Plan Medical Directors to ensure compliant, efficient care

Qualifications

• Current nursing licensure in state(s) of employment.
• BSN or ADN degree from an accredited school or college of nursing.

Responsibilities

• Conducts Managed Care Programs in conjunction with third party administrators’ health care agreements.
• Performs complex care coordination and referral management with Access Coordinators.
• Supports insurance issue resolution and compliant operations with health plans.

Skills

Clinical coordination

Team collaboration

Education

BSN or ADN degree

Job description

Building Location:

Business Service Center

Department:

1007190 PRE-SERVICE AUTHORIZATION - EH SS

Job Description:

Conducts Managed Care Programs in conjunction with third party administrators’ health care agreements. Works collaboratively with and provides clinical expertise and leadership to Access Coordinators to perform all aspects of managed care, including the referral, prior authorization/precertification processes, using and revising Essentia Health’s established policies and procedures for managed care activities. Performs complex care coordination and referral management. Works collaboratively with the Essentia Health customer service personnel to provide efficient service for insurance issue resolution and smooth operations. Works collaboratively with clinical areas and business services both internally and externally. Supports efforts and participates with the Supervisor of Contracting & Payor Relations and the Health Plans Medical Directors regarding health care initiatives and compliance issues for health plans.

Education Qualifications:

This position is on our infusion therapy team. The team works oncology and nononcologic infusion therapy referrals, with the addition to PET Scans and radiation oncology. It involves submitting treatment and therapy plans to insurance for prior authorization and/or reviewing insurance policies to make sure patient meets policy before care is provided.

Licensure/Certification Qualifications:

Certification/Licensure Required:

• Current nursing licensure in state(s) of employment

BSN or ADN degree from an accredited school or college of nursing

FTE:

1

Possible Remote/Hybrid Option:

Remote

Shift Rotation:

Day Rotation (United States of America)

Shift Start Time:

0800

Shift End Time:

1630

Weekends:

Holidays:

No

Call Obligation:

No

Union:

Compensation Range:

$70,595.20 - $105,892.80

Employee Benefits at Essentia Health:At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at [phone].

It is our policy to afford EEO to all individuals, regardless of race, religion, color, sex, pregnancy, gender identity, national origin, age, disability, family medical history, genetic information, sexual orientation, marital status, military service or veteran status, culture, socio-economic status, status with regard to public assistance, and other factors not related to qualifications, including employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants, or membership or activity in a local human rights commission, or any other category as defined by law.