Registered Nurse Pre-Service Authorization

Essentia Health; United States; Remote; USD 71.000 - 106.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

401(k) matching

Tuition reimbursement

Flexible scheduling

Generous time off

Wellness resources

Zusammenfassung

Essentia Health is seeking a Nurse Care Coordinator to manage complex referral workflows and prior authorization tasks within infusion therapy and oncology support services. You will work across clinical and administrative teams to ensure compliant, timely access to therapies for patients in the United States.

The role emphasizes collaboration with Health Plans, policy adherence, and operational efficiency, with a possible remote/hybrid work arrangement and day shifts.

Qualifikationen

• Current nursing licensure in state(s) of employment is required.
• BSN or ADN degree from an accredited school or college of nursing.
• Demonstrated clinical leadership and care coordination skills.
• Experience with referrals and prior authorization processes preferred.

Aufgaben

• Perform complex care coordination and referral management.
• Provide clinical expertise and leadership to Access Coordinators.
• Collaborate with customer service to resolve insurance issues efficiently.
• Support health plan initiatives and ensure compliance with policies.

Kenntnisse

Clinical leadership

Care coordination

Referral management

Ausbildung

BSN or ADN in nursing

Current nursing licensure in state(s) of employment

Jobbeschreibung

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: Union Posting Deadline: 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 your HR Service Center at [phone].

Essentia Health mission and values

Essentia Health seeks employees who embrace our commitment to patient- and family-centered care in communities both large and small. We're looking for people who are committed to making patients and their families feel known and understood. People who understand what it means to be Here with you. People who are willing to use their strengths to help others. Our Values Quality | Hospitality | Respect | Joy | Justice | Stewardship | Teamwork

Essentia Health is an Equal Opportunity/Affirmative Action Employer. Essentia Health does not discriminate in employment because of age, color, creed, culture, disability (physical or mental), ethnicity, familial status, gender identity or expression, genetic information, language, local Human Rights Commission activity, national origin, military service, race, religion, sex, sexual orientation, socioeconomic status, or public assistance status.

Job offers are contingent upon successful completion of post-offer screenings. Screenings includes verification of your legal right to work in the United States, a health screening and immunization review, verification of applicable licensure, certifications, education, and experience, and background checks including criminal, urine drug screen and MVR where required.