Registered Nurse Pre-Service Authorization

Essentia Health; Minnesota; Hybrid; USD 71,000 - 106,000; Full time

Benefits offered by this job

Medical insurance

401(k) plan

Tuition reimbursement

Job summary

Essentia Health in Minnesota is seeking a nurse to join the infusion therapy team to manage pre-service authorization and referral processes for oncology and related therapies.

You will review insurance policies, submit treatment plans for prior authorization, and ensure patient eligibility while collaborating with Access Coordinators and Health Plans Medical Directors. This is a full-time role with possible remote/hybrid options and comprehensive benefits.

Qualifications

• Active nursing licensure in state(s) of employment.
• BSN or ADN from an accredited nursing program.
• Willingness to work in infusion therapy and oncology referrals.

Responsibilities

• Perform pre-service authorization and referral management for infusion therapy.
• Collaborate with Access Coordinators and health plans for approval processes.
• Review policies and ensure patient eligibility before care is provided.
• Coordinate with clinical areas and business services to support operations.

Skills

Care coordination

Clinical leadership

Communication

Education

BSN or ADN

Job description

Building Location:Business Service CenterDepartment:1007190 PRE-SERVICE AUTHORIZATION - EH SSJob 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 employmentBSN or ADN degree from an accredited school or college of nursingFTE:1Possible Remote/Hybrid Option:RemoteShift Rotation:Day Rotation (United States of America)Shift Start Time:0800Shift End Time:1630Weekends:Holidays:NoCall Obligation:NoUnion:Union Posting Deadline:Compensation Range:$70,595.20 - $105,892.80Employee 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].