RN Referral Management Coordinator (Virtual) - Prior Authorizations - 40 Hours - Day Shift - HA[...]

Henry Ford Health System; Troy (MI); Remote; USD 65,000 - 85,000; Full time

Job summary

A leading healthcare organization is seeking a Remote RN Referral Management Coordinator. The role involves managing prior authorizations and peer-to-peer interactions, requiring a nursing diploma and clinical management experience. Join a dedicated team in a meaningful role that offers career advancement and flexible work from home arrangements.

Benefits

Comprehensive health benefits

Opportunity for career advancement

Qualifications

• Minimum of two years of clinical management experience in an inpatient or ambulatory setting.
• Registered Nurse with current Michigan licensure.
• Ability to work effectively in a team-oriented environment.

Responsibilities

• Process referral requests by verifying network assignments.
• Coordinate peer-to-peer conversations with the Medical Director.
• Track physician non-compliance with Utilization Management Policies.

Skills

Strong computer skills

Attention to detail

Team-oriented

Education

Nursing Diploma

Bachelor's Degree in Health Care or related field

Job description

RN Referral Management Coordinator (Virtual) - Prior Authorizations - 40 Hours - Day Shift - HAP Health Alliance Plan

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Full-time position with a structured schedule: Monday through Friday, 8:00 AM to 4:30 PM
- Opportunity for career advancement within a growing team of healthcare professionals
- Work remotely from the comfort of your home
- Engage in meaningful work by reviewing medical necessity and criteria for prior authorizations
- Collaborative environment with a dedicated team of Registered Nurses and Administrative Professionals
- Benefit-eligible position with comprehensive health benefits

What to Expect (Job Responsibilities):
- Process referral requests by verifying network assignments and assessing clinical appropriateness
- Coordinate peer-to-peer conversations with the Medical Director and providers
- Manage denial processing and communicate with providers regarding denial letters
- Report potential quality of care issues to the Quality Management Department
- Track physician non-compliance with Utilization Management Policies & Procedures

What is Required (Qualifications):
- Nursing Diploma required
- Minimum of two (2) years of recent clinical management experience in an inpatient or ambulatory setting, or two (2) years in Utilization or Quality Management
- Registered Nurse (RN) with current Michigan licensure
- Strong computer skills and attention to detail
- Ability to work effectively in a team-oriented environment

How to Stand Out (Preferred Qualifications):
- Bachelor's Degree in Health Care or related field
- Experience in working with medical necessity criteria
- Familiarity with Utilization Management processes
- Strong communication skills for peer-to-peer interactions
- Ability to identify and report quality of care issues effectively

#HealthcareServices #RemoteWork #NursingJobs #CareerGrowth #QualityManagement

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About the company

The Henry Ford Health System is a comprehensive, integrated, non-profit health care organization in Metro Detroit.

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