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Prior Authorization/Care Management Nurse Job Description (Monday- Friday 8:00 a.m.- 4:30p.m).
GENERAL SUMMARY:
The Prior Authorization/Care Management Nurse (medications/treatments) will contact insurance companies, on behalf of Littleton Regional Healthcare Physician Practices, to verify patient specific benefits and authorizations/referrals for medications and treatments as required by the insurance carrier. This nurse will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage. This nurse may be asked to work denials on the authorizations that had been obtained. This nurse will work to coordinate care for medication management with outpatient/inpatient infusion centers. This nurse will work to coordinate care with home health agencies in assisting with medication and care management of patients within our communities.
ESSENTIAL FUNCTIONS:
MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES:
PHYSICAL DEMANDS:
See Physical Demands worksheet
WORK ENVIRONMENT:
Exposure to communicable diseases, toxic substances, bodily fluids, medicinal preparations and other conditions common to a clinic environment.
PHYSICAL ENVIRONMENT
Exposed to all patient elements including exposure to human waste. At times, long andirregular hours are necessary. Exposure to hazardous substances is, at times, unavoidable. Frequently, multiple tasks and patient needs must be addressed in a rapid fashion with prioritizing life-threatening situations and organization of the remainder of the needs.
PROBABILITY AND CONSEQUENCES OF ERRORS
Errors in practice can result in negative patient outcome. Individual practice affects probability of error. Poor performance in meeting job description criteria will be addressed according to established progressive disciplinary policies and procedures of Littleton Regional Hospital and the New Hampshire Nurse Practice Act.
Full Time
$83k-103k (estimate)
03/23/2024
05/16/2024