Job Description

Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks
Pay Rate Type: Annual Salary

Listed is the base hiring salary range offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary range listed is just one component of the total rewards/compensation package offered to candidates.
Min = $75,504.000
Mid = $98,155.200

Summary:

 The prior authorization nurse reviews requests for medical treatments, services, or procedures to determine whether they qualify for insurance coverage. The job requires nurses to assess, evaluate, and provide recommendations to help ensure patients receive the services they need; he/she will evaluate authorization requests and authorize, modify or pend per appropriate criteria. They will also refer authorization requests not meeting criteria to specialty physician reviewer according to established medical necessity, benefit and eligibility criteria to assure appropriate, efficient and timely medical care. Work with payers regarding appeals process for services rendered. 

Responsibilities:

 Review and process urgent and non-urgent authorization requests (via phone, fax and electronic submission) for medical necessity (according to established criteria) and authorize, pend or modify as appropriate Obtain additional medical information as necessary from requesting provider.3. Communicate with providers and members regarding status of authorization requests Collaborate with centralized Authorization specialist to ensure bi-furcation process of information being submitted to payers Review and Research Authorization denials in collaboration with PFS and other teams as necessary Review and submit appeals for denied services 7. Assist with submitting appeals that are in via pending in WQ’s Collaborate with Medical Directors and other designated physician leaders for making clinical decisions. Review and process urgent and non-urgent authorization requests (via phone, fax and electronic submission) for medical necessity (according to established criteria) and authorize, pend or modify as appropriate. Utilize a variety of medical necessity, contractual and benefit criteria to determine appropriate authorization decisions. Obtain additional medical information as necessary from requesting provider Assist interdepartmental staff members to resolve issues relating to the authorization process. Refer information regarding members to other departments as appropriate for follow-up (i.e., Case Management Process authorization requests (routine, urgent and retrospective) according to department performance standards. Collaborate with Medical Directors and other designated physician leaders for making clinical decisions. Perform other duties as assigned by supervisor/manager.


Minimum Requirements:

  • REGISTERED NURSE (RN)
  • 3+ years in clinical nursing experience. 
  • Excellent verbal and written communication skills. 
  • Ability to work effectively with a variety of customers including physicians, office staff, and members. 
  • Ability to work independently with self-initiative and discipline. 
  • Working knowledge of personal computers. 
  • Knowledge ICD-10, CPT and HCPCS coding. Optimum organizational skills with ability to meet expected and unexpected timelines. 
  • Previous experience with Epic Tapestry platform preferred but not required.


Why Yuma Regional Medical Center?

Yuma Regional Medical Center (YRMC) is located in Yuma, AZ. Our purpose is building a healthier tomorrow. We strive by putting patients first as they are the center of every decision and action we take. YRMC is rooted in the community by living and breathing the dynamic nature of our region. Being committed to progress by constantly and consistently advancing healthcare, creating meaningful experiences and improving the lives of everyone around us.

Our Values

Bring Kindness | Achieve Together | Aspire For Better | Do The Right Thing | Lead With Optimism |

About Yuma, AZ

Named by the Guinness World Records as the Sunniest City on Earth with winters averaging temperatures of 70 degrees, sunny days and cooler nights.

Yuma, Arizona is a place to explore the great outdoors with hiking, jet skiing, boating and off-roading. Don’t forget to soak up the sun at the great Colorado River or one of Yuma’s many lakes.

Yuma is centrally located in Southwest Arizona, within a short drive to many popular attractions and destinations.

https://www.visityuma.com/

https://www.yumachamber.org/

Bring your skills to one of the sunniest places on earth - Yuma, AZ!

Physical Requirements and working conditions for this position will be provided to you up on interview. 

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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