Grand River Medical Group is seeking a Registered Nurse (RN), Licensed Practical Nurse (LPN) or Certified Medical Assistant (CMA) to work 36-40 hours/week as the Prior Authorization Nurse.
Primary duties include, but not limited to:
- Initiate prior authorization process by processing clinical requests requiring medical review of the patient’s electronic chart.
- Review prior authorization requests and communicate with the healthcare team when additional information is needed.
- Contact appropriate insurance carrier to obtain prior authorization approval number.
- Record prior authorization numbers and information into the patient’s electronic medical record.
- Notify appropriate healthcare team when a prior authorization request is denied or a peer to peer review is necessary.
- Maintain a thorough understanding of authorization requirements and plan contracts.
- Handle all requests for prior authorizations in a timely and accurate manner.
Experience: Minimum of one year nursing experience, prior authorization and/or clinical experience preferred.
Requirements: RN or LPN degree or CMA certification. Have and maintain current certification of BLS.
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Paid Sick Leave
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