Remote Prior Authorization Rn Jobs in Lexington, KY

Why Planned Parenthood?

Working at Planned Parenthood Great Northwest, Hawai’i, Alaska, Indiana, Kentucky is more than a job.  It provides the opportunity to contribute to our powerful mission and perform meaningful work.

In healthcare services, this means a commitment to providing the absolute best in patient care and education. Our exceptional health center staff drives our mission forward by upholding our acclaimed customer service & confidentiality standards, and working to create a safe, judgement-free space for anyone seeking Planned Parenthood services.

About our Clinical Director of Virtual Care Programs position

Provide clinical and operational leadership for centralized follow-up (CFU), the Telehealth service line, and patient navigation and care coordination programs across six affiliate states (Indiana, Kentucky, Idaho, Washington State, Alaska, Hawaii).

What will you be doing!

Serve as the senior advanced practice clinician responsible for clinical oversight, quality, workflows, regulatory compliance, crossstate licensing coordination, staffing, and program development for both licensed and nonlicensed remote staff (APC, RN, case managers, patient navigators). Ensure safe, timely, patient-centered follow-up and telehealth care consistent with policies and medical standards.

Key Responsibilities:

•  Clinical leadership & oversight
  • Provide clinical direction, case review, and supervision for CFU APCs, CFU RNs, Telehealth clinicians, and service line managers.
  • Provide oversight of the affiliate's complex/urgent followup care using audit and other evaluation tools to ensure compliance with medical standards
  • Work with other clinical leadership to ensure effective communication between service lines.
  • Provide clinical consultation to staff for highrisk or complex cases and support decisions about patient continuity of care.
  • Guide patient navigation and case management work to ensure timely access to care.
• Program operations & quality
  • Oversee centralized followup workflows: initiation of follow up, documentation standards, care path management and resolution, and tracking/reporting.
  • Establish, refine, and standardize Telehealth clinical protocols, care paths and escalation pathways between Telehealth and inaffiliate clinical teams.
  • Lead quality assurance audits, identify gaps, and implement corrective action plans for CFU and Telehealth services.
  • Ensure compliance with affiliate policies, PPFA MS&Gs, state regulations, and telehealth licensure/telemedicine requirements.
• Staffing, training & supervision
  • Hire, mentor, and manage remote care staff (APCs, RNs, case managers, patient navigators) and oversee training and competency of designees and nonlicensed staff involved in follow up and telehealth communication.
  • Coordinate with Clinical Trainers, Operations Leadership, Health Center Managers, and Medical Records/Patient Access teams to support workflows and data integrity.
• Crossstate licensure & regulatory coordination
  • Support clinician licensing, credentialing, and practice privilege requirements for all six states; ensure all clinicians providing care are appropriately licensed and compliant.
  • Monitor and implement statespecific reporting requirements (e.g., STI mandated reporting) and telehealth regulatory changes.
• Communication & stakeholder management
  • Serve as primary clinical liaison between CFU, Telehealth, affiliate medical leadership, Prior Authorization Navigators, Gender Affirming Care Navigators, and Medical Records/Patient Access teams.

Minimum Qualifications:

• Advanced practice clinician: NP, CNM, or PA (active, unrestricted license in at least one U.S. state)
• Eligible to obtain and maintain licensure in Indiana, Kentucky, Idaho, Washington State, Alaska, and Hawaii upon hire.
• Minimum 10 years clinical experience as an APC, with at least 5 years in leadership/supervisory roles and demonstrated experience in telehealth, care coordination, or centralized follow up systems.
• Strong competency with EHRs (experience building/using care paths preferred), telehealth platforms, and remote clinical workflows. EPIC experience is preferred.
• Knowledge of reproductive health clinical standards, abnormal diagnostic result management, and state reporting requirements preferred.

Preferred Qualifications:

• Prior experience managing centralized follow up programs, telehealth service lines, or multistate clinical operations.
• Experience in quality improvement, policy development, and staff training/education.
• Familiarity with PPFA medical standards and MS&Gs or similar family planning/sexual and reproductive health organizations.

Core competencies & skills:

• Clinical judgment and ability to triage and manage urgent/complex cases remotely.
• Leadership and people management: coaching, performance management, crossfunctional collaboration.
• Excellent written and verbal communication for patient notification standards and staff guidance.
• Strong organizational skills, comfort with data/reporting, and process improvement mindset.
• Cultural humility and commitment to equitable, patientcentered care.

Working conditions & travel:

• Fully remote role with required periodic travel to affiliate sites and inperson leadership meetings as needed.
• Flexible hours may be required to provide clinical coverage or to collaborate across time zones for WA/AK/HI and IN/KY/ID.
• Candidates must reside in one of our six states to be considered.

Supervisory responsibility:

• Direct supervision of CFU APCs, CFU RNs, Telehealth clinicians (as applicable), and oversight responsibilities for nonlicensed designees involved in patient navigation and other follow up.

Compensation:

The salary range for this position varies based on the employee’s primary work location:

• Washington: $138,552 – $257,311 annually
• Alaska: $131,625 – $244,446 annually
• Hawaii: $124,697 – $231,580 annually
• Idaho, Indiana, and Kentucky: $117,769 – $218,714 annually

*Actual starting pay will be determined based on factors including, but not limited to, relevant experience, education, internal equity, geographic location, and the budgeted hiring range established for the position.

Position Type:

Full-time – Exempt

Benefits Eligibility:

This position is eligible for PPGNHAIK benefits.  As part of our total compensation, we provide a comprehensive benefits plan including medical, dental and vision plans, retirement, paid time off, short and long-term disability and life insurance.  For additional information about our benefits program, please send an email to hre.contacts@ppgnhaik.org.

Other Information:

All of our employees must present proof of receiving a current flu shot prior to their first day of employment.

What we expect from you.

• That you adhere to our code of conduct, policies, procedures, and protocols.

• That you always demonstrate a high degree of professionalism.

• That you always support and model our customer service standards.

• That you value continuous learning and seek ongoing training and development.

Our commitment to diversity:

At PPGNHAIK, we’ve outlined our priorities and goals as we continue to cultivate and promote a diverse, equitable, & inclusive culture that champions dignity, care, and respect, and where employees feel welcomed and motivated to do their best. These priorities reflect our promise to support programs and initiatives that promote continuous learning and organizational development and discussions on DEI topics; provide internal developmental opportunities; and assess what more we can do to nurture a supportive and equitable work environment.

Equal Employment Opportunity

PPGNHAIK is an Equal Opportunity Employer.  Equal Opportunity will be provided to all employees and applicants for employment on the basis of their ability and competence without unlawful discrimination on the basis of their race, color, ethnicity, national origin, gender, gender identity, gender expression, sexual orientation, religion, protected veteran status, marital status, age, disability, or any other status protected by applicable state or federal law