Prior Authorization Nurse
Hospice of the Valley
Job Info
Hospice of the Valley is a national leader in hospice care and has been serving the Phoenix metropolitan area since 1977. A mission-driven, not-for-profit organization, Hospice of the Valley employs compassionate, skilled professionals who are committed to excellence, enjoy teamwork and contribute daily to our mission and culture of caring. Team members experience a friendly, supportive atmosphere, leadership support, autonomy, flexibility and the privilege of doing meaningful, rewarding work.
Position Profile
Responsible for completion and submission of initial prior authorization requests as well as requests for extensions of prior authorization and prior authorization updates due to level of care/location of care changes. The ideal candidate has outstanding customer service, organization, people, and written communication skills, is extremely detail oriented, and flexible.
Responsibilities:
§ Obtains prior authorization
- Obtains prior authorization upon patient admission, outreaches within plan guidelines for extension requests and for authorization updates due to level of care/location of care changes.
- Ability to discuss hospice services and health plan coverage/guidelines with Hospice of the Valley staff and health plan staff, answer related questions, and provide documentation whenever needed.
- Documents consistent, detailed notes and status in EMR.
- Tightly manages daily workflow.
- Task oriented with strong critical thinking skills and ability to see the big picture of the end-to-end process.
- Tracks and monitors daily patients pending hospice admission in order to immediately submit authorization requests upon admission.
- Accurately and thoroughly completes prior authorization requests in order to improve the likelihood of receiving authorization.
§ Responds timely and effectively to health plan questions and requests.
§ Reads health plan communications to ensure timely and accurate compliance with requirements, regulations and guidelines.
§ Serves as resource for process review, improvements and changes.
§ Maintains and enhances professional skills.
§ Adheres to high standards of personal and professional conduct.
Minimum Qualifications
§ Graduate of accredited school of nursing and current AZ LPN or RN license in good standing.
§ 3 years nursing experience.
§ 1-2 years healthcare administrative experience.
§ 6 mo-1year hospice experience.
§ Knowledge of Medicare and health plan guidelines related to hospice benefits preferred.
§ Strong computer skills, including Word and Excel in a Microsoft Windows environment.
§ Possesses professional image, enthusiasm and self-motivation.
§ Identifies and resolves problems in a timely manner.
§ Gathers and analyzes information skillfully.
§ Manages time effectively, meets deadlines and performs assigned duties with attention to detail, speed, accuracy and follow-through.
§ Works independently with minimal supervision; self-starter while also being a team player and flexible.
§ Proven ability to deal with personal and confidential information in a professional manner.
Preferred Qualifications
§ Knowledge of Medicare and health plan guidelines related to hospice benefits preferred.
Hospice of the Valley offers competitive salaries and excellent benefits that include medical, dental and vision plans, generous paid time off, a matching 401k, tuition assistance, an award-winning wellness program and a host of employee recognition and rewards. Employees also receive comprehensive orientation, training and development opportunities.
Hospice of the Valley is an equal employment opportunity employer. EOE/M/F/D/V
This job has expired.
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