What are the responsibilities and job description for the Prior Authorization Nurse position at Rush Memorial Hospital?
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JOB SUMMARY
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The Surgery Prior Authorization/pre-surgical nurse obtains and performs clinical reviews of prior authorization requests using appropriate criteria as designated by insurance companies/Medicare. The prior authorization nurses will promote the quality and cost effectiveness of patient care using clinical acumen. Works to complete encounters and ensure accuracy. Will also enter and maintain clinical information in multiple health management systems. Also assists with pre-surgery clinic to educate and collect anesthesia data upon scheduling surgery. .
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MINIMUM QUALIFICATIONS
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Knowledge & Experience
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Skills-
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Demonstrates ability to give and follow instructions accurately
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Demonstrates effective interpersonal skills necessary to interact with various levels of health care personnel
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Demonstrates efficiency in computer/insurance website navigation.
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Knowledge-
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Hospital administrative and nursing policies and procedures
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Collaborate with various staff within provider networks and coordinate with clinic, billing, and coding to help optimize revenue cycle
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Education-
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Graduate of accredited program in registered nursing or licensed practical nursing
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Current registration as a Registered Nurse with the state of Indiana Health Professions Bureau
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Experience-
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Minimum of two (2) years of clinical nursing experience
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Preferred experience in coding and insurance prior authorization navigation.
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Authority and Accountability-
Extensive exposure to confidential information or matters
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Frequent contact with various persons or groups within and outside of the hospital including employees, department managers, physicians, patients, visitors and outside agency personnel
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Must be able to work with and communicate with different types of people
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Aptitudes-
Must be able to prioritize, utilize critical thinking, and adjust to change
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Must be able to reason and use logical problem-solving skills
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Performs duties that require some latitude for independent judgment and initiative in handling situations out of the ordinary
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Must be self-directed, flexible and willing to assume additional responsibilities as needed
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Must have a strong service orientation and professionalism
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