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Full Time Prior Authorization Rn Jobs in Tennessee

StatCare, LLC

Prior Authorization Coordinator

Knoxville, TN · On-site

$15.25 - $19/hr

StatCare strives to work collaboratively with hospital partners, nurses, and support staff ... In-Person, Full-Time, Monday - Friday BENEFITS: * 401(k) * Dental insurance * Health insurance

IVX Health

Prior Authorization Coordinator

Brentwood, TN · On-site +1

$17.50 - $21.75/hr

In addition to cash pay, full-time regular employees are eligible for 401(k), health benefits, and other company-provided benefits. Prior Authorization Coordinator Pay Range $22--$24 USD About IVX ...

Ascension

Prior Authorization Representative

Nashville, TN · On-site +1

$21.31 - $28.84/hr

Days | Full-time Salary: $21.31 to $28.84 per hour How you'll make an impact in this role ... What additional requirements you'll need * 2+ years of surgical prior authorization experience Life ...

CivicMinds, Inc.

Registered Nurse

Murfreesboro, TN · On-site

Registered Nurse Location:- Richmond, VA Job Type:- Full-time Responsibilities will Include ... Intake/Prior Authorization team, our Purchasing Team, Home Infusion/Specialty Pharmacy team, and ...

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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 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.

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 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 most commonly searched types of Prior Authorization Rn jobs in Tennessee?

The most popular types of Prior Authorization Rn jobs in Tennessee are:

What cities in Tennessee are hiring for Full Time Prior Authorization Rn jobs?

Cities in Tennessee with the most Full Time Prior Authorization Rn job openings:

Full Time Prior Authorization Rn jobs near you

Prior Authorization Coordinator

Knoxville, TN • On-site

StatCare, LLC
See more jobs at StatCare, LLCexternal

$15.25 - $19/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 26 days ago

Job description

Description
StatCare is a private Pulmonary, Critical Care, Sleep, and Hospitalist medical practice dedicated to providing high-quality inpatient & outpatient care to patients throughout East Tennessee. Our physicians and advanced practice providers are committed to delivering patient-centered care to ensuring continuity, expertise, and compassion at every stage of hospitalization. StatCare strives to work collaboratively with hospital partners, nurses, and support staff, improving health outcomes and elevate the standard of care for the communities we are proud to serve.
Prior Authorization Coordinator is responsible for securing prior authorizations for diagnostic testing, including but not limited to CT scans, MRIs, and other procedures, ensuring patients receive timely access to care while minimizing delays in treatment. The ideal candidate will work closely with providers, patients, insurance companies, and diagnostic facilities to ensure all authorizations are obtained accurately and efficiently.
Examples of Duties: (List does not include all duties assigned)
  • Obtain prior authorizations for diagnostic testing (CT scans, MRIs, etc.) and pulmonary-related procedures.
  • Verify insurance coverage and requirements before submitting authorization requests.
  • Communicate with insurance companies, providers, and diagnostic centers to facilitate approvals.
  • Track and follow up on pending authorizations to ensure timely completion.
  • Document all authorization activities in the patient's medical record and maintain accurate records.
  • Notify providers and patients promptly of authorization status, including denials and next steps.
  • Collaborate with clinical and administrative staff to prevent delays in patient care.
  • Assist with appeals or re-submissions when necessary.
  • Maintain confidentiality and compliance with HIPAA and all applicable regulations.

KNOWLEDGE, SKILLS, AND ABILITIES
  • Minimum of 1-2 years of prior authorization, insurance verification, or medical office experience (pulmonary or specialty office experience preferred).
  • Knowledge of insurance guidelines, medical terminology, and diagnostic testing procedures.
  • Proficiency with electronic health records (EHR) and Microsoft Office Suite.
  • Excellent communication and customer service skills.
  • Ability to work independently and as part of a team in a fast-paced environment and multi-task.
  • Ability to apply policies and principles to solve everyday problems and deal with a variety of situations.
  • Ability to work effectively with physicians, patients, staff and the public.
  • Ability to establish priorities and coordinate work activities.

Educaton: High School Diploma or GED required.
WORK LOCATION: In-Person, Full-Time, Monday - Friday
BENEFITS:
  • 401(k)
  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance

StatCare symbolizes excellence, every patient, every time. Our success is built on a strong foundation of high-quality patient-centered care, physician ownership, collaborative relationships, and entrepreneurial spirit. We foster a culture rooted in professionalism, trust, and communication - values that extend across our internal teams and our external relationships with healthcare partners.

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