Vacancy expired!
RN-Medical Prior Authorization Review NurseChange Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities. RN-Medical Prior Authorization Review Nurse Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities. Work Location: Augusta, Maine
Position:
The Medical Prior Authorization Nurse (Med PA nurse) is responsible for: Using the various electronic systems to receive, review, and research requests from community providers for prior authorization of medical supplies and services. The Medical PA nurse will utilize sound clinical judgement, critical thinking skills, appropriate criteria, and knowledge of best practices to ensure accurate decisions of requests for medical supplies and services.Core Responsibilities: Responsible for continued development of working knowledge of Maine Medicaid Prior Authorization Medical Policy and contractual performance requirements and suggest potential improvements and/or changes as appropriate
Manage and disposition the Prior Authorization (PA) as may be assigned
Perform day to day activities required for PA processing and follow defined business rules and policies, including timeliness requirements
Work with the Medical PA unit staff members to monitor work queues and complete assigned tasks
Escalate difficult clinical or complex reviews/dispositions to the Operations supervisor based on business rules and workflows policies
Requirements:
Registered Nurse with an active Maine License
Experience working in a variety of clinical settings
Working understanding of managed care
Intermediate-Advanced MS Office Suite skills
Good communicator with strong written and oral skills, including excellent spelling and grammar
Preferred Qualifications:
Previous work with Durable Medical Equipment a plus
Ability to adapt and be agile to changing situations
Demonstrated ability to meet deadlines, organize multiple tasks, solve problems, communicate complex ideas and work collaboratively with clients and other partners
Must demonstrate knowledge and have the proven ability to collaborate effectively with individuals, legal representative, if any, community providers and other resources
Excellent customer service skills
Working Conditions/Physical Requirements:
General office demands
Unique Benefits:
Flexible work environments
Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
Employee wellbeing programs and generous health plans
Educational assistance programs
US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
Learn more at https://careers.changehealthcare.com
Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.
Feeling Inspired? Ready to #MakeAChange? Apply today!
Diversity and Inclusion:
At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity Feeling Inspired? Ready to #MakeAChange? Apply today!
COVID Vaccination Requirements
We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when j ob-related and consistent with business necessity , we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.Equal Opportunity/Affirmative Action Statement Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCPEEOSupplementFinalJRFQA508c.pdf.If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.Click here https://www.dol.gov/ofccp/pdf/pay-transp%20EnglishformattedESQA508c.pdf to view our pay transparency nondiscrimination policy.California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) . Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.