RN Pre-Service Authorization
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At a glance
Requirements
Credentials this posting asks for.
Job overview
The RN Pre-Service Authorization role conducts managed care programs, providing clinical expertise and leadership to Access Coordinators for referral, prior authorization, and care coordination. The RN collaborates with customer service, clinical areas, and business services to resolve insurance issues and support health plan initiatives while adhering to Essentia Health policies.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
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:
BSN or ADN degree from an accredited school or college of nursing
Licensure/Certification Qualifications:
Certification/Licensure Required:
- Current nursing licensure in state(s) of employment
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:
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 (218) 576-0000.
It is our policy to afford EEO to all individuals, regardless of race, religion, color, sex, pregnancy, gender identity, national origin, age, disability, family medical history, genetic information, sexual orientation, marital status, military service or veteran status, culture, socio-economic status, status with regard to public assistance, and other factors not related to qualifications, including employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants, or membership or activity in a local human rights commission, or any other category as defined by law.
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