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Full Time Prior Authorization Rn Jobs in New York

Hope Christian Services

Full-Time Nurse (RN)

Wyckoff, NJ · On-site

$42 - $45/hr

Join Our Team as a Nurse - Full-Time RN - Make a Real Impact on Resident Care! Are you a ... Employee shall submit to drug testing prior to employment * Employee shall submit to drug testing ...

Hope Christian Services

Full-Time Nurse (RN)

Wyckoff, NJ · On-site

$42 - $45/hr

Join Our Team as a Nurse - Full-Time RN - Make a Real Impact on Resident Care! Are you a ... Employee shall submit to drug testing prior to employment * Employee shall submit to drug testing ...

VillageMD

Registered Nurse - Rheumatology

Clifton, NJ

$40.38 - $50.48/hr

The RN will be motivated, energetic, and an empathetic communicator who is passionate about ... Initiates and follows through with prior authorization requests, DME orders, home health referrals

VillageMD

Registered Nurse - Rheumatology

Clifton, NJ · On-site

$40.38 - $50.48/hr

The RN will be motivated, energetic, and an empathetic communicator who is passionate about ... Initiates and follows through with prior authorization requests, DME orders, home health referrals

Rising Ground, Inc.

Registered Nurse (RN)

Bronx, NY · On-site

$92K/yr

... Full time position-hours are based upon the needs of the Program and will be discussed prior to ... Authorized to work in the U.S. * Ability to work in-person in New York City (NYC) * Ability to ...

Jawonio

PROS Registered Nurse

New City, NY · On-site

$40 - $46/hr

Complete prior authorizations as needed with insurance companies and follow-up to obtain ... BSN and RN with two years related experience and/or training; or equivalent combination of ...

Jawonio

PROS Registered Nurse

New City, NY · On-site

$40 - $46/hr

Complete prior authorizations as needed with insurance companies and follow-up to obtain ... BSN and RN with two years related experience and/or training; or equivalent combination of ...

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Full Time Prior Authorization Rn information

What is a full time prior authorization RN?

Full Time Prior Authorization Registered Nurses (RNs) are healthcare professionals who work primarily in administrative roles to review and evaluate medical service requests. Their main responsibility is to determine if specific treatments, medications, or procedures meet insurance company criteria for coverage before they are provided to patients. They use their clinical knowledge to assess medical necessity and ensure compliance with healthcare policies and guidelines. These nurses typically interact with physicians, insurance companies, and patients to manage authorizations and appeals, ensuring that care is both appropriate and covered under a patient’s health plan.

What is the difference between Full Time Prior Authorization Rn vs Medical Coder?

AspectFull Time Prior Authorization RnMedical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), knowledge of medical coding systems
Work EnvironmentHealthcare facilities, insurance companies, utilization review departmentsMedical offices, hospitals, insurance companies, coding agencies
Job FocusReviewing and authorizing medical procedures and treatmentsTranslating medical records into standardized codes for billing

While both roles require healthcare knowledge, the Full Time Prior Authorization RN focuses on evaluating medical necessity for treatments, whereas Medical Coders translate medical documentation into codes for billing. Both are essential in healthcare administration but serve different functions within the patient care and billing process.

What are the key skills and qualifications needed to thrive as a full time prior authorization RN, and why are they important?

To thrive as a Full Time Prior Authorization RN, you need a strong nursing background (active RN license), in-depth knowledge of medical terminology, and experience with insurance processes or utilization review. Familiarity with prior authorization software, electronic health records (EHRs), and insurance payer portals is typically required. Exceptional attention to detail, critical thinking, and strong communication skills help you effectively evaluate medical necessity and advocate for patient care. These abilities ensure timely, accurate authorizations, reduce claim denials, and promote optimal patient outcomes.

What are some typical challenges faced by full time prior authorization RNs, and how can they be managed?

Full Time Prior Authorization RNs often encounter challenges related to navigating complex insurance guidelines, managing high caseloads, and ensuring timely communication between healthcare providers and payers. Staying organized, keeping up-to-date with frequently changing insurance policies, and developing strong collaboration skills with both clinical and administrative teams are key to success in this role. Leveraging electronic health records and standardized workflows can also help streamline the authorization process and reduce delays for patients.

Is full time prior authorization RN a stressful job?

Full-time prior authorization RNs often experience stress due to managing high volumes of insurance requests, strict deadlines, and the need for accuracy in documentation. The role requires strong organizational skills and attention to detail, which can contribute to job pressure, especially during busy periods or complex cases.
What are the most commonly searched types of Prior Authorization Rn jobs in New York? The most popular types of Prior Authorization Rn jobs in New York are:
What cities in New York are hiring for Full Time Prior Authorization Rn jobs? Cities in New York with the most Full Time Prior Authorization Rn job openings:
Full Time Prior Authorization Rn jobs near you

RN Clinical Lead-South Troy Health Center

Trinity Health

New York, NY • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Trinity Health rating

6.6

Company rating: 6.6 out of 10

Based on 354 frontline employees who took The Breakroom Quiz

570th of 887 rated healthcare providers

Job description

Employment Type:
Full timeShift:
Day Shift
Description:
RN Clinical Lead - Troy Health Center - Troy, NY - FT
If you are looking for an RN Clinical Lead position in Troy, this could be your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places. This position is located at 79 Vandenburg Ave Troy.
Position Highlights:
  • Recognized leader: Magnet Hospital in the Capital Region
  • Quality of Life: Where career opportunities and quality of life converge
  • Advancement: Strong orientation program, generous tuition allowance and career development
  • Work/Life: Monday - Friday, Office Hours

What you will do:
RN Clinical Lead - the practice of the profession of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential health problems through such services as case finding, health teaching, health counseling, and provision of care supportive to or restorative of life and well-being, and executing medical regimens prescribed by a licensed physician or other licensed health care provider. Additionally this position requires collaboration with manager and providers to ensure clinical protocols and processes are followed and manage clinical coverage appropriately.
Job Duties and Responsibilities
This description is intended to only provide basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. These responsibilities are subject to change at any time.
  • Brings patient to exam room, takes appropriate vital signs and documents in electronic medical record.

  • Notifies provider regarding patient in need of intervention.

  • Identifies patients with ED, Hospital Admission or specialty consults and obtains records.

  • Review and reconcile medication list to ensure accurate and complete list in electronic medical record (EMR) available for provider review and submission.

  • Records patients' chief complaint in EMR.

  • Complete referrals and tracks patients' compliance.

  • Review prescriptions electronically and send prescriptions to providers for review and submission.

  • Obtains prior authorization for diagnostic testing and medication and enters into EMR.

  • Responds to patient's concerns appropriately using AIDET communication.

  • Acknowledge- Greet the patient by name. Make eye contact, smile and acknowledge family or friends in the room.

  • Introduce - Introduce yourself with your name, skill set, professional certification, and experience.

  • Duration- Give an accurate time expectation for tests, physician arrival, and identify next steps. When this is not possible, give a time in which you will update the patient on progress.

  • Explanation- Explain step-by-step what to expect next, answer questions, and let the patient know how to contact you, such as a nurse call button.

  • Thank You- Thank the patient and/or family. You might express gratitude to them for choosing your hospital or for their communication and cooperation. Thank family members for being there to support the patient.

  • Educates patients on procedures and obtains patient consent as directed by provider.

  • Performs pre-visit planning and reviews quality metrics.

  • Retrieves telephonic clinical information from patients who call into the office.

  • Triage calls and provide advice to patients.

  • Submit to provider for review and guidance as necessary.

  • Follow up with patients within same business day.

  • Documents clinical guidance and patient response in patient's medical record.

  • Monitors task list and completes tasks assigned by provider in a timely manner based on urgency.

  • Uses Universal Precautions with all encounters, and follows procedure for handling occurrences involving exposure to blood or other body fluid.

  • Educates patients regarding medication, testing procedures and home care techniques.

  • Ensure proper labeling, handling and documentation for patient specimens.

  • Follow up with patient regarding test results based on advice given by provider.

  • Ensures that patient exam rooms are stocked and cleaned at all times.

  • Routinely rotates and checks for expiration dates on all medical supplies.

  • Reviews supplies and notifies designated colleagues of ordering supplies prior to supply depletion.

  • Performs mandatory in-service training including but not limited to OSHA and harassment.

  • Maintains a clean and safe work environment including disinfecting patient care areas and equipment.

  • In conjunction with other nursing colleagues, maintains the medical supply cabinet and drug cabinet.

  • Prepare and administer vaccines and medications/injections utilizing the six (6) R's:

  • Right Medication

  • Right Dosage

  • Right Time

  • Right Route

  • Right Patient

  • Right Documentation

  • Completes incoming patient forms and ensures forms are scanned into the EMR.

  • Handles medical waste appropriately.

  • Communicates respectfully with internal and external customers.

  • Uses the electronic medical record to communicate effectively.

  • Maintains current license and certifications required based on NYS requirements.

  • Attends and participates in all required meetings and trainings.

  • Performs quality assurance duties as assigned.

  • Provides a clinical visit summary (Patient Plan) to patient as requested.

  • Provides educational materials.

  • Mandatory reporting; abuse and neglect, vaccine adverse event reporting system (VAERS).

  • Report patient safety events into MIDAS system and maintain yearly training.

  • Participates in daily Patient Care huddles as appropriate.

  • Maintains patient confidentiality and adheres to HIPAA regulations.

  • Adheres to all St. Peter's Health Partners policies and procedures at all times. Up to and including:

  • Code of Conduct

  • Corrective Action

  • Attendance Guidelines

  • Behavior in the Workplace

  • Dress Code

  • Hand hygiene and Artificial Nails

  • Works cooperatively with all colleagues to ensure quality patient care at all times.

  • Performs nurse visits as scheduled following standing orders given by providers.

  • Performs other duties as assigned.

Daily Responsibilities:
  • Collaborate with Manager to ensure that the team is working collectively for best patient outcomes, including monitoring clinical workflow issues such as:

  • Communicate with clinical team members to ensure that patient flow is efficient, and any issues with patient experience are addressed.

  • Monitor Clinical Inbox for aging cases to ensure staff completion in a timely manner.

  • Monitor open encounters and follow up with responsible team member for processing.

  • Ensure clinical staff are monitoring incoming voicemail and patient cases to provide appropriate response within a timely manner.

  • Ensure that fridge temperatures are checked for temperature variances.

  • Maintain and Monitor all emergency equipment and supplies.

  • Ensure huddle of the clinical team is carried out per office routine.

  • Ensure that applicable Point of Care Testing (POCT) quality controls (QC's) are run on day of service and are within appropriate range.

  • Work with care team members to follow up on quality metrics, hospitalization, and ER utilization where appropriate.

  • Monitor office staff to ensure HIPPA compliance in office setting

  • Monitor infection control practices performed by office staff.

  • Troubleshoot clinical office equipment and follow up as needed for repairs

  • Provide clinical education to all clinical colleagues to support new initiatives and uphold clinical standards.

  • Identify and recognize exceptional clinical performance, and encourage growth including mentorship program.

Weekly Responsibilities:
  • Download Data loggers for refrigerator / freezer temps, print and added to the binder with monthly temp logs

  • Site walkthrough for regulatory issues (stock, expiration, compliance) - this is ongoing

  • Monitor biohazard disposal and maintenance

  • Monitor exam rooms for proper stocking of supplies and other materials needed for patient care

Ensure all workstations and patient care areas are clean and free from clutter
  • Photocopy and send all POCT QC logs to the point of care testing department. Hard copies kept in office for reference as needed.

  • Inspection of below areas to ensure no expired supplies / medications are present:

  • All exam rooms

  • Clean supply room

  • Hallway (soap, sanitizer)

  • Lab area

  • Medication room

  • Nurses station

  • Fridge Thermometers

  • Control Solutions

  • Work with office manager, staff , and informatics to ensure understanding of quality metrics including reporting

Annual Responsibilities:
  • Ensure that Biomed Inspection occurs on all medical equipment and inspection stickers are in place (scales, EKG machines, POCT equipment, AED, etc.)

  • POCT competencies for staff

Primary Cares sites:
  • Complies with (PCMH) Patient Centered Medical Home Care delivery model.

  • Participates in all PCMH staff meetings as appropriate.

  • Participates in all PCMH training as appropriate.

Specialty Care sites:
  • All specialty practice locations will have additional items that may be included in the responsibilities and oversight of the RN Clinical Lead.

Qualifications
  • Current unencumbered NYS RN license

  • Basic Life Support certification

  • Ability to influence and motivate others to perform their job effectively and to be responsible for making decisions on workflow

  • Excellent attention to detail and organization

  • Commitment to confidentiality and respect

  • Demonstrated ability to handle multiple priorities in a deadline-driven environment

  • Understand and embrace a customer service focus

  • Ability to work independently, yet function collaboratively as a team

  • Basic Computer Competency

Pay Range
$37.00 - $48.52
Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

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About Trinity Health

Sourced by ZipRecruiter

Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Livonia, MI, US

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