[Hiring] Registered Nurse Pre-Service Authorization @Essentia Health

Role 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:

• Referral processes
• Prior authorization/precertification processes

Uses and revises Essentia Health’s established policies and procedures for managed care activities. Performs complex care coordination and referral management. Works collaboratively with:

• Essentia Health customer service personnel to provide efficient service for insurance issue resolution
• 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.

Qualifications

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

Requirements

• This position is on our infusion therapy team, working with oncology and nononcologic infusion therapy referrals, including PET Scans and radiation oncology.
• Involves submitting treatment and therapy plans to insurance for prior authorization and/or reviewing insurance policies to ensure patient meets policy before care is provided.

Benefits

• Comprehensive medical, dental, vision, life, and disability insurance
• Supplemental options to fit your needs
• 401(k) plan with employer contributions
• Professional development through training, tuition reimbursement, and educational programs
• Flexible scheduling and generous time off
• Wellness resources focused on physical, mental, and emotional health

Company Description

At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.