Registered Nurse Pre-Service Authorization

Building Location: Business Service Center Department: 1007190 PRE-SERVICE AUTHORIZATION - EH SS Job Description: Conducts Managed Care Programs in conjunction with third party administrators’ health care agreements. Works collaboratively with and provides clinical expertise and leadership to Access Coordinators to perform all aspects of managed care, including the referral, prior authorization/precertification processes, using and revising Essentia Health’s established policies and procedures for managed care activities. Performs complex care coordination and referral management. Works collaboratively with the Essentia Health customer service personnel to provide efficient service for insurance issue resolution and smooth operations. Works collaboratively with clinical areas and business services both internally and externally. Supports efforts and participates with the Supervisor of Contracting & Payor Relations and the Health Plans Medical Directors regarding health care initiatives and compliance issues for health plans. Education Qualifications: This position is on our infusion therapy team. The team works oncology and nononcologic infusion therapy referrals, with the addition to PET Scans and radiation oncology. It involves submitting treatment and therapy plans to insurance for prior authorization and/or reviewing insurance policies to make sure patient meets policy before care is provided.  Licensure/Certification Qualifications: Certification/Licensure Required: • Current nursing licensure in state(s) of employment BSN or ADN degree from an accredited school or college of nursing FTE: 1 Possible Remote/Hybrid Option: Remote Shift Rotation: Day Rotation (United States of America) Shift Start Time: 0800 Shift End Time: 1630 Weekends: Holidays: No Call Obligation: No Union: Union Posting Deadline: Compensation Range: $70,595.20 - $105,892.80 Employee Benefits at Essentia Health:
At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at [phone in the portal].