Job Description
HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 190+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a
Prior Authorization Nurse ! JOB SUMMARY: The purpose of the prior authorization nurse is to provide timely review of authorization requests and ensure the requests meet national standard and contractual requirements. The prior authorization nurse will promote the quality and cost effectiveness of patient care using clinical acumen. Additionally, the nurse will prepare documentation, perform audits of patient records, and assist management when needed. The nurse must be versed in the application of clinical guidelines.
ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES: - Perform clinical reviews of authorization request using appropriate criteria
- Provide accurate and complete documentation with rationale used to approve request
- Collaborate with various staff within provider networks and case management team coordinate patient care
- Equip and train prior authorization coordinator with needed resources
- Ability to multitask between computer and multi-line phone requests
- Participate in interdepartmental projects when needed
- Enter and maintain clinical information in multiple health management systems
- Apply clinical criteria
QUALIFICATION REQUIREMENTS: Skills, Knowledge, Abilities: - Advanced verbal, written communication and organizational skills
- Strong service orientation and professionalism
- Drive to work well with a team
- Advanced and proficient computer skills- Microsoft office suite
Training/Education: - Bachelor or Associates Degree in Nursing ( Bachelor's preferred)
- NYS Registered Nurse license
- Minimum of two (2) years of experience in acute clinical nursing setting
Experience: - Minimum of two (2) years of experience in acute clinical nursing setting
- Knowledge of utilization management and case management principles preferred
- Knowledge of managed care operations and benefit management
- Prior authorization experience preferred
Salary Information: Annual Base Compensation: $70,000 - $80,000 per year
Bonus Incentive: Up to 5%, based on organizational performance
HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Job Tags
Full time, Work at office, Local area,