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Overnight Prior Authorization Rn Jobs in Michigan

Trinity Health

RN

Chelsea, MI · On-site

The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work ...

Trinity Health - IHA

RN

Chelsea, MI · On-site

The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work ...

Trinity Health - IHA

RN

Ann Arbor, MI · On-site

The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work ...

Trinity Health

RN

Ypsilanti, MI · On-site

The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work ...

Trinity Health - IHA

RN

Livonia, MI · On-site

The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work ...

Trinity Health - IHA

RN

Ypsilanti, MI · On-site

The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work ...

Trinity Health - IHA

RN

Brighton, MI · On-site

The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work ...

Integrated Resources INC

Registered Nurse

Troy, MI

Provides concurrent review and prior authorizations (as needed) according to policy for members as ... Completion of an accredited Registered Nursing program. (a combination of experience and education ...

CVS Health

Registered Nurse

Roseville, MI

$60K - $129K/yr

Registered Nurse Company: Oak Street Health Role Description: The purpose of a Registered Nurse at ... prior authorizations. * Conduct thorough and accurate reviews of patient medications and update as ...

Oak Street Health

Registered Nurse

Roseville, MI · On-site

$60K - $129K/yr

Registered Nurse Company: Oak Street Health Role Description: The purpose of a Registered Nurse at ... prior authorizations. * Conduct thorough and accurate reviews of patient medications and update as ...

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Overnight Prior Authorization Rn information

What is the difference between Overnight Prior Authorization Rn vs Medical Assistant?

AspectOvernight Prior Authorization RnMedical Assistant
CredentialsRegistered Nurse (RN) licensePost-secondary certificate or diploma
Work EnvironmentHospitals, clinics, insurance companiesDoctor's offices, clinics, outpatient facilities
Job FocusReviewing insurance authorizations, patient advocacyAssisting with patient care, administrative tasks

The Overnight Prior Authorization RN primarily handles insurance approvals and patient advocacy during overnight shifts, requiring RN licensure. In contrast, Medical Assistants focus on direct patient care and administrative support in outpatient settings. While both roles support healthcare operations, their credentials, responsibilities, and work environments differ significantly.

What is an Overnight Prior Authorization RN?

An Overnight Prior Authorization RN is a Registered Nurse who works overnight shifts to review and process requests for prior authorization of medical services, procedures, or medications. Their role involves evaluating clinical documentation to determine if requested treatments meet insurance or organizational guidelines for approval. These nurses collaborate with providers, patients, and insurance companies to ensure timely and appropriate care. Working overnight allows for 24/7 coverage, supporting urgent cases and maintaining continuous workflow in healthcare authorization departments.

What are some unique challenges faced by Overnight Prior Authorization RNs, and how can they effectively manage them?

Overnight Prior Authorization RNs often work independently with limited immediate support, which can present challenges such as handling complex cases without direct peer consultation and maintaining focus during non-traditional hours. They must be adept at managing high volumes of authorization requests, prioritizing urgent cases, and communicating effectively with providers and insurance companies outside regular business hours. Staying organized, utilizing clear documentation, and leveraging electronic health record systems can help manage workload efficiently. Building strong relationships with day-shift colleagues for smooth case handoffs is also crucial for success in this role.

What are the key skills and qualifications needed to thrive as an Overnight Prior Authorization RN, and why are they important?

To thrive as an Overnight Prior Authorization RN, you need a current RN license, strong clinical judgement, and in-depth knowledge of insurance guidelines and medical necessity criteria. Familiarity with prior authorization software, electronic health records (EHR), and payer-specific systems is typically required. Exceptional attention to detail, critical thinking, and effective communication skills are vital for navigating complex cases and collaborating remotely. These skills ensure timely and accurate authorization decisions, supporting patient care and compliance during overnight shifts.
What are the most commonly searched types of Prior Authorization Rn jobs in Michigan? The most popular types of Prior Authorization Rn jobs in Michigan are:
What cities in Michigan are hiring for Overnight Prior Authorization Rn jobs? Cities in Michigan with the most Overnight Prior Authorization Rn job openings:
Overnight Prior Authorization Rn jobs near you
RN

RN

Trinity Health

Chelsea, MI • On-site

Other

Re-posted 12 days ago

Trinity Health rating

6.5

Company rating: 6.5 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

607th of 886 rated healthcare providers

Job description

POSITION DESCRIPTION:
Provides professional nursing care for patients following established standards and practices, which can include triage (telephone and walk-in visits), and care needs that transpire between office visits. The position ensures timely access to appropriate services, reduces care fragmentation, and promotes optimal health outcomes and patient safety. Demonstrates professional clinical leadership and oversight within the scope of the RN role.
ESSENTIAL JOB FUNCTIONS:
The following job functions may not be the responsibility of all RN's. Some RN's will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work supporting a provider inbox.)
  1. Responsible for efficiently triaging patient needs via telephone and during visits to ensure appropriate timely access to the appropriate level of care, reducing avoidable emergency department visits and readmissions according to IHA's Policies and Protocols.
  2. Conducts post-discharge calls for patients experiencing a transition of care for identified populations.
  3. Documents clinical findings in a clear and concise manner according to IHA Policy.
  4. Utilizes critical thinking skills within the scope of licensure to appropriately assess patient needs and involves providers as appropriate.
  5. Enters orders (medication, laboratory, radiology, referrals) according to provider direction and as per state, local and professional guidelines.
  6. Follows clinical and nursing protocols as applicable.
  7. Schedules patient appointments as applicable.
  8. Encourages patient portal usage and supports where needed.
  9. Provides scope-appropriate nursing education during all patient interactions.
  10. Consults with providers and other extended care team members (Care Management, Embedded Pharmacy, Behavioral Health and Nutrition) and external case managers as appropriate to effectively ensure quality patient care.
  11. Supports physician and advanced practice providers with indirect work according to protocol. This includes and is not limited to test results/orders management.
  12. Assesses patients for gaps in care for preventative and disease management needs.
  13. Ensures patient medication list is accurate, completes medication reconciliation and processes refill requests per protocol.
  14. Works with the entire care team to co-manage indirect patient work according to Standard Work Instructions.
  15. Collaborates with insurance, DME, home care and all other care partners to ensure patient needs are met.
  16. Reviews patient medical history to identify supporting documentation relevant to ordered services and procedures to assist with or complete prior authorization process.
  17. Assists patients with resources for any social influences of health needs.
  18. Participates in process improvement projects within the office/department.
  19. Serves as a resource to clinical office/department staff within scope of RN role; may direct the work of LPN and Medical Assistant staff as needed and appropriate based on role/scope.
  20. May perform clinical support tasks as outlined on the Clinical Support Staff Scope of Practice document.
  21. Supports other offices, attends required meetings and training, and participates in committees as requested.
  22. Attends weekly patient care meetings and attends daily huddles as applicable.
  23. Assumes additional duties as required.
ORGANIZATIONAL EXPECTATIONS:
  1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of Trinity Health Medical Group.
  2. Must be able to work effectively as a member of the clinical care team.
  3. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
  4. Successfully completes all relevant organizational training and adheres to Trinity Health Medical Group standard of care as outlined in the Trinity Health Code of Conduct.
  5. Maintains knowledge of and complies with Trinity Health Medical Group standards, policies and procedures.
  6. Maintains general knowledge of Trinity Health Medical Group office services and in the use of all relevant office equipment, computer and manual systems.
  7. Maintains strict confidentiality in compliance with Trinity Health Medical Group and HIPAA guidelines.
  8. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
  9. Uses resources efficiently.
  10. If applicable, responsible for ongoing professional development - maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.
MEASURED BY:
Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.
ESSENTIAL QUALIFICATIONS:
EDUCATION: Graduate of an accredited Registered Nurse program.
CREDENTIALS/LICENSURE: Valid, unrestricted RN license in the State of Michigan. Valid CPR certification.
MINIMUM EXPERIENCE: 1-2 years of clinical experience in a medical or physician office preferred. Previous nursing experience not required.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
  1. Demonstrated competency in obtaining accurate patient vital statistics (height, weight, blood pressure, temperature, etc.) and patient health history.
  2. Must have basic knowledge and understanding as to the relevance of patient vital statistics to the patients' health history.
  3. Proficient/knowledgeable in medical terminology.
  4. Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, email, e-learning, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job.
  5. Excellent communication skills in both written and verbal forms, including proper phone etiquette.
  6. Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
  7. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups.
  8. Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
  9. Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations.
  10. Ability to exercise sound judgement and problem-solving skills.
  11. Ability to perform mathematical calculations needed during the course of performing basic job duties, i.e.: calculating proper dosages for immunizations.
  12. Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
  13. Ability to handle patient and organizational information in a confidential manner.
  14. Ability to travel to other office/practice sites and meeting and training locations.
  15. Successful completion of IHA competency-based program within introductory and training period.
MINIMUM PHYSICAL EXPECTATIONS:
  1. Physical activity that often requires keyboarding, phone work and charting.
  2. Physical activity that often requires time working on a computer.
  3. Physical activity that often requires lifting over 50 lbs.
  4. Physical activity that sometimes requires handling and lifting patients, transferring patients to gurney using slide board, assisting patients with dressing/undressing, transferring patients to wheelchair using gaitbelt, walking, bending, stooping, reaching, climbing, kneeling and/or twisting.
  5. Physical activity that sometimes requires lifting, pushing and/or pulling up to 100 lbs.
  6. Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus.
  7. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
  8. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:
This job operates in a medical facility and requires regular walking to various locations around the hospital/clinic. Employees will be working where there is patient care equipment. Hazardous materials, including bloodborne pathogens and bodily fluids are also present. Exposure to sharps, x-rays, patients' conditions and some unpleasant sights, smells and contagious diseases are possible. This position requires significant interaction with people (many of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.

What Trinity Health employees say

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Benefits

Hours and flexibility

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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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