Registered Nurse Prior Authorization Specialist - Holland, United States - Holland Hospital

Description

CURRENT HOLLAND HOSPITAL EMPLOYEES

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As a Registered Nurse Prior Authorization Specialist for Holland Hospital Pharmacy Services, you will play a crucial role in helping patients receive critical medications and treatments by efficiently navigating the complexities of prior authorization and financial assistance.

You will be responsible for interacting with insurance companies, healthcare providers, and patients to ensure timely access to necessary care.

Required license or certification:

Registered Nurse [RN]Minimum Education/Training Required:
Graduate of accredited Registered Nursing Program required.

Current Michigan RN license required.1-2 years of work experience with insurance prior authorization, patient access, care management, and/or ambulatory/home infusion practices.

Pay Range:
$ $49.25Employment Type:

Full Time, 80 hours every two weeksSchedule: 7:30am - 4:00 pm, no weekends or holidaysPrior Authorization ManagementReview and complete prior authorization requests for medications and other associated services, adhering to hospital policies and payer guidelines.

Research and maintain detailed knowledge of insurance coverage criteria and prior authorization requirements for a wide range of medications and procedures.

Proactively communicate with physicians and other healthcare providers to gather supporting documentation and clarifications for authorizations.
Advocate for patients through negotiation with insurance companies to secure approvals for denied or denied-with-appeal authorizations.
Track and monitor the status of all active prior authorizations and ensure timely submission of necessary documentation before deadlines.

Educate patients on prior authorization processes and address questions/concerns within scope of your license, re-routing to pharmacist or other healthcare providers as appropriate.

Acts as point of contact for complex cases, addressing patient concerns, insurance challenges, and coordinating solutions with appropriate disciplines.
Financial Assistance ManagementResearch medication assistance programs (MAP) or additional resources to optimize patient access to vital medications.

Enroll patients for co-pay cards, foundation grants, and manufacturer-supported programs including eligibility assessments, coordination with patient, pharmaceutical companies and providers as applicable.

Resolve payer or program denials, support patients, and collaborate with providers for seamless medication access.

Professional Development and CollaborationStay up-to-date on changes in regulations and payer policies related to prior authorizationParticipate in training and development opportunities to enhance skills and knowledge.

Collaborate effectively with other team members across departments and disciplines to ensure smooth workflow and excellent patient experience.

Communicate effectively with other team members to identify opportunities to modify or enhance workflows to support patient, provider, pharmacy and organizational goals.

Able to work independently and as part of a professional team in a fast-paced environment.
Holland Hospital is an Equal Opportunity Employer, please see our EEO policy#J-18808-Ljbffr