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Manager Prior Authorization Rn Jobs in Tennessee

Dallas IVF

RN

Memphis, TN · On-site

$30 - $35.10/hr

The RN will coordinate and manage clinical activities related to infertility evaluation and ... Ensure medication ordering and prior authorizations are completed appropriately * Track and verify ...

IVY FERTILITY

RN

Memphis, TN · On-site

$30 - $35.10/hr

The RN will coordinate and manage clinical activities related to infertility evaluation and ... Ensure medication ordering and prior authorizations are completed appropriately * Track and verify ...

MERCY HEALTH SERVICES INC

RN/LPN - PRN

Smyrna, TN · On-site

$25.50 - $34.50/hr

Submitting prior authorizations for psychiatric medications. * Working in collaboration with ... Must have a current licensed practical nurse (LPN) or Registered Nurse (RN) license in TN. * Basic ...

Mercy Health

RN/LPN - PRN

Smyrna, TN · On-site

$25.50 - $34.50/hr

Submitting prior authorizations for psychiatric medications. * Working in collaboration with ... Must have a current licensed practical nurse (LPN) or Registered Nurse (RN) license in TN. * Basic ...

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Manager Prior Authorization Rn information

What is the difference between Manager Prior Authorization Rn vs Nurse Case Manager?

AspectManager Prior Authorization RnNurse Case Manager
CredentialsRN license, certifications in prior authorizationRN license, case management certification
Work EnvironmentUtilization review, insurance companies, healthcare administrationPatient advocacy, care coordination, healthcare facilities
Employer & IndustryInsurance companies, healthcare organizationsHospitals, clinics, insurance providers

The Manager Prior Authorization Rn primarily focuses on reviewing and approving insurance claims for medical procedures, ensuring compliance with policies. Nurse Case Managers coordinate patient care, advocate for patients, and manage treatment plans. While both roles require RN licensure and healthcare knowledge, the Manager Prior Authorization Rn emphasizes administrative review, whereas Nurse Case Managers are more involved in direct patient care coordination.

Is manager prior authorization RN a stressful job?

Manager Prior Authorization RNs often experience stress due to managing complex approval processes, strict deadlines, and high caseloads. The role requires strong organizational skills and attention to detail, which can contribute to job pressure, especially in fast-paced healthcare environments.

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 Manager Prior Authorization Rn jobs?

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

Manager Prior Authorization Rn jobs near you

Specialist-Authorization Denial

Baptist Memorial Health Care Corporation

Memphis, TN • On-site

$17.50 - $23.25/hr

Full-time

Re-posted 5 days ago

Baptist Memorial Health Care rating

7.3

Company rating: 7.3 out of 10

Based on 115 frontline employees who took The Breakroom Quiz

301st of 898 rated healthcare providers

Job description

Overview
Summary
Authorization Denial Specialist ensures that chemotherapy (specialty group) and other infusions/radiation therapy/radiology/ surgical services meet medical necessity and appropriateness per insurance medical policies/ FDA/NCCN guidelines. Initiates and coordinates pre-certifications/prior authorizations per payer guidelines prior to services being rendered and completes the Insurance verification process.
Reviews clinical information and supporting documentation for outpatient or Part B services authorization denials to determine and perform retro authorizations, reconsiderations or appeal actions to defend the revenue. Performs other duties as assigned.
Responsibilities
• Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
• Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services. Utilize multiple healthcare websites
• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner
• Responsible for completing the Insurance Verification process
• Works closely with physicians and clinic staff obtain authorizations to promote positive patient outcomes, timely treatment and positive reimbursement
• Understands and complies with regulatory requirements by specific insurance companies and facilitates compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff.
• Reviews, assesses and evaluates all authorization denial communications received in order to optimize reimbursement
Requirements, Preferences and Experience
Minimum Required
3 - 5 years of business experience in a healthcare environment with 2 of those years being in a clinical setting.
Preferred/Desired
5 years of business experience in a healthcare environment with at least 3 years payer specific experience.
3 years clinical experience in a clinical care setting
Pre-certification experience desired.
Education
Minimum Required
Skill in communicating clearly and effectively using standard English in written, oral, and verbal format to achieve high productivity and efficiency. Skill to write legibly and record information accurately as necessary to perform job duties. Strong organizational skills. Ability to type and/or key correctly
Preferred/Desired
Associates degree or 2 years of college level courses.
Training
Minimum Required
Requires critical thinking and judgement.
Preferred/Desired
Must demonstrate the ability to appropriately use standard criteria established by payers.
Special Skills
Excellent customer service and communication skills. Ability to speak, articulate, and be understood clearly.
Minimum Required
Ability to read and understand medical policies, compendiums, LCDs, and FDA guidelines. Must be able to multi-task and be flexible. Advance computer literacy skills and problem-solving skills. Ability to deal with confrontational issues and high stress situations with patients, family, and physicians.
Preferred/Desired
Knowledge of oncology pre-certification requirements and guidelines.
Licensure
Preferred/Desired
Pharmacy Tech, CHAA, RHIT, LPN, RN
About Baptist Memorial Health Care

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About Baptist Memorial

Sourced by ZipRecruiter

Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

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