Prior Authroization Nurse

Company: Memorial Health
Location: Decatur
Posted on: April 8, 2021

Job Description:

Overview
Reviews all DMH and DMG scheduled inpatient and outpatient procedures and outpatient diagnostic services to validate the scheduled procedure or diagnostic service has the appropriate payor authorization or meets the payor's medical policies, there is a valid physician order, and other clinical documentation requirements are met prior to the scheduled procedure or diagnostic service.

Qualifications
Education and/or Other Requirements
Must be an RN or LPN with current Illinois license. Five years experience in clinical nursing is required.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

• Must possess good communication and interpersonal relationship skills.
• Must be able to organize work with minimal supervision.
• Must be able to focus attention to minute details.
• Above average computer skills including Word, Excel and software applications required.
  General Skill Requirements
  In addition to the Essential Functions and Qualifications listed above, to perform the job successfully an individual must also possess the following General Skill Requirements.
  
  • Adaptability - Adapts to changes in the work environment; Manages competing demands; Accepts criticism and feedback; Changes approach or method to best fit the situation; ability to work with frustrating situations; work under pressure and on an irregular schedule such as unscheduled overtime, unanticipated changes in work pace; Works with numerous distractions.
  • Attendance and Punctuality - Schedules time off in advance; Begins working on time; Keeps absences within guidelines; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
  • Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; Exhibits good listening and comprehension; Keeps others adequately informed; Selects and uses appropriate communication methods.
  • Cooperation - Establishes and maintains effective relations; Exhibits tact and consideration; Displays positive outlook and pleasant manner; Offers assistance and support to co-workers; Works cooperatively in group situations; Works actively to resolve conflicts.
  • Job Knowledge - Competent in required job skills and knowledge; Exhibits ability to learn and apply new skills; Keeps abreast of current developments; Requires minimal supervision; Displays understanding of how job relates to others; Uses resources effectively.
  • Judgment - displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions; ability to work with and maintain confidential information.
  • Problem solving - Identifies problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Resolves problems in early stages; Works well in group problem solving situations.
  • Quality - Demonstrates accuracy and thoroughness; Displays commitment to excellence; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
  • Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly; Achieves established goals.
  • Concentration - Maintains attention to detail over extended period of time; continually aware of variations in changing situations.
  • Supervision - ability to perform work independently or with minimal supervision; ability to assign and/or review work; train and/or evaluate other employees.
    
    Associated topics: license, licensed vocational, licensed vocational nurse, mtp, nurse iv, nurse lpn, nurses, practical nurse lpn, vocational, vocational nurse

Keywords: Memorial Health, Decatur , Prior Authroization Nurse, Healthcare , Decatur, Illinois