Nurse - Prior Authorization
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Augusta, ME 04330
Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact.
*As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.
If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare.*
Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.
Empower Your Future. Make a Difference.
What will I be responsible for in this job?
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 Med PA nurse will utilize sound clinical judgement, critical thinking skills, appropriate criteria, and knowledge of best practice to ensure accurate decisions of requests for medical supplies and services.
- 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.
- Provide supporting clinical information and documentation for escalated PAs
- Respond to questions and concerns from interested parties regarding the PA criteria and processes timely.
- Participate in the preparation for and attend administrative hearings providing clinical and policy input.
What are the requirements?
- Years of experience: 5 years
- Education: Active RN License in State of Maine
- Physical requirements:Office Demands
What critical skills are needed for you to consider someone for this position?
- Working understanding of managed care.
- Intermediate-Advanced MS Office Suite skills
- Experience working in a variety of clinical settings preferred
- Previous work with Durable Medical Equipment a plus
What other skills/experience would be helpful to have?
- 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 ability to collaborate effectively with individuals, legal representative, if any, community providers and other resources.
- Good communicator with strong written and oral skills, including excellent spelling and grammar
- Excellent customer service skills
- Must possess and demonstrate good problem solving and critical thinking skills
- Attention to detail
- Ability to work well under pressure in a fast-paced, time sensitive environment with shifting priorities and multiple deadlines
- Must be extremely detail oriented
- Good presentation skills
Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!
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/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.
If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to email@example.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_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.
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. Employment at Change Healthcare is based upon your individual merit and qualifications. We don’t discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, marital status, protected veteran status or disability, genetic characteristic, or any other characteristic protected by applicable federal, state or local law. We will also make all reasonable accommodations to meet our obligations under the Americans with Disabilities Act (ADA) and state disability laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability.