Prior Authorization Rn Jobs in Kentucky (NOW HIRING)

Make a Difference in the Lives of Children Every Day Are you passionate about pediatric care and looking for a rewarding specialty nursing opportunity? We are seeking a dedicated Registered Nurse to join our Pediatric Rheumatology team in a day-shift position focused on caring for children with rheumatic diseases, including juvenile arthritis, autoimmune conditions, and musculoskeletal disorders.

As a Pediatric Rheumatology Division Nurse, you will work alongside a collaborative team of specialists committed to providing exceptional care to children and their families. You will become a trusted resource and advocate for patients, helping them manage chronic conditions so they can participate more fully in school, sports, and everyday activities.

• Build meaningful relationships with patients and families throughout their healthcare journey.
• Provide education, support, and hands‑on clinical care.
• Serve as a knowledgeable resource for patient questions and concerns.
• Develop expertise in the specialized and growing field of pediatric rheumatology.
• Collaborate with providers and multidisciplinary team members to deliver high-quality, patient‑centered care.

• Supportive team environment built on collaboration, respect, and excellent communication.
• Day‑shift schedule that promotes work‑life balance.
• Opportunities to form lasting connections with patients and families.
• Meaningful work that directly improves the health and well‑being of children throughout our community.
• Professional growth and specialization in a unique pediatric nursing specialty.

The Ambulatory Divisional Registered Nurse provides, develops, coordinates, and manages clinical duties related to the specific service line division. This job will support clinical care across multiple outpatient locations, requiring interdisciplinary partnership with multiple providers within the division.

The position collaborates with Ambulatory Leadership, Division Chair, Medical Director, in the development and management of processes to provide safe, timely ambulatory care needs. The Ambulatory Divisional Registered Nurse will have a working knowledge of outpatient management of patients within a specialty division, including general medical, complex medical, pre‑operative and post‑operative care.

• Follows documented physician/licensed provider orders, within the boundaries of the Nurse Practice Act, licensure, and established standards, policies, and practice guidelines.
• Triages patient calls and in basket messages in accordance with ambulatory and division specific standards.
• Facilitates training as needed to improve the specialty knowledge base across all ambulatory clinic locations.
• Partners with care team to complete chart prep for return visits; reviews records (lab work, imaging, diagnostic reports) prior to patient visit.
• Completes necessary new patient referrals, ensures outside records are available, performs chart review/prep to ensure patients are scheduled into the correct clinic.
• Provides disease and procedure‑specific education to patients in clinic.
• Creates educational materials to support commonly encountered topics within division.
• May assist providers during clinical procedures across the division.
• Partners with providers, Assistant Clinical Manager, Program Coordinators, and Nurse Navigators to ensure continuity of care across clinic sites for division patients with expertise in service, preoperative, postoperative, and medical management to specific patient populations.
• Performs multi‑site nursing visits as directed by providers to include education, treatments, or assessments.
• Supports prior authorization requirements specific to emergent / same day prior authorizations and denial appeals.
• Partners with Assistant Clinical Manager and clinic nursing staff to aid providers in obtaining clinic testing and treatment.
• Consistently monitors patient satisfaction and customer feedback, taking prompt action on issues striving for service excellence.
• Serves as a nursing clinical role model and division subject matter expert for management of ambulatory patients across multiple sites.
• Seeks collaborative relationships that can lead to effective partnerships in research, evidence based practice or process improvement.
• Contributes to revising and developing clinical practice and/or nursing care guidelines for specific patient populations using current best evidence and shares the synthesis of current best evidence at the department/division level .
• Takes appropriate actions to enhance positive outcomes, even in the most challenging situations.
• Anticipates needs to provide quality and efficient care for patients.
• Maintains professional growth and development in specialty through ongoing process of formal and informal education and training.
• Performs other duties as assigned and/or participates in special projects in order to support the mission of VCUHS and the division.
• Accepts alternate assignments as required.

Demonstrates the knowledge and skills necessary to provide equitable care appropriate to the age of the patients served on their assigned unit. Demonstrates knowledge and related competencies of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to their age, specific needs and to provide the equitable care needed as described in departmental policies and procedures.

Neonates (0-4 weeks), Infant (1-12 months), Pediatrics (1-12 years), Adolescents (13-17 years), Adults (18-64 years), Geriatrics (65 years and older)

Required Education: Bachelor’s degree in nursing from an accredited program

Preferred Education: Master’s degree in nursing from an accredited program

Required: Current Registered Nurse license, BLS Certification.

Preferred: Nursing specialty board certification preferred.

Years and Type of Required Experience: Minimum 3 years of nursing experience required. 1-2 years preferred experience in the designated pediatric or adult division.

Required: Strong communication and time management skills. Ability to set priorities, make timely decisions, and meet multiple deadlines. Ability to work collaboratively within a large complex, fast‑paced environment.

Preferred: N/A

• Periods of high stress and fluctuating workloads may occur.
• General office environment.
• May be exposed to physical altercations and verbal abuse.
• Required to car travel to off‑site locations, occasionally in adverse weather conditions.
• Travel between clinic sites is required. Long‑distance or air travel as needed‑not to exceed 10% travel.
• May be exposed to high noise levels.
• May be exposed to limited hazardous substances or body fluids.
• May be exposed to human blood and other potentially infectious materials.
• May have periods of constant interruptions.
• Prolonged periods of working alone.
• Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

• Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (50-100 lbs.), Stoop, Kneel, Squat, Climbing, Balance, Bending Work Position: Sitting, Walking, Standing.
• Additional Physical Requirements/ Hazards: Manual dexterity (eye/hand coordination), Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision.
• Hazards: Depth perception, Exposure to toxic/caustic/chemicals/detergents, Exposure to moving mechanical parts, Exposure to dust/fumes.
• Mental/Sensory – Emotional.
• Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking.
• Emotional: Fast pace environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change.

Range $35.16 - $58.05. Actual salary offers will be based on several key factors to include relevant work experience, credentials, and qualifications.

EEO Employer/Disabled/Protected Veteran

Inventing better care, day by day by discovery. Sound outrageous? It absolutely is. Sound impossible? That’s never stopped us before. Sound like hard work, intense research, collaboration with experts around the world, sheer brainpower meets unrelenting willpower? That’s. Exactly. Right. We’ll do whatever it takes to offer the best in care and empower the best in quality of life. And it’s an approach that works — whether it’s a patient who undergoes a new, life‑saving procedure or a clinical researcher who finds promise in a new cancer treatment, exciting new medicine is happening at VCU Health. We have it all: One college and four health sciences schools, An academic medical center, A Level I trauma center, One of only two NCI‑designated cancer centers in Virginia, The region’s only full‑service children’s hospital, More than 800 physicians in 200 specialties, With a community health center, dedicated research teams, facilities and valued partners in every field. Our medical teams are top notch. And we’re not too shy to boast of internationally known physicians, some recognized as the best in the country, top‑ranked local specialists and all‑around all-stars at every level. From our very first years to our most recent advancements, we are driven to learn more, dig deeper, teach passionately and never rest in order to be a true leader in discovering what’s possible in health and recovery. We are a comprehensive system of care and a pioneer of health. Read VCU Health Year In Review for more about our accomplishments.