Prior Authorizations RN - Full-time

pbJOB SUMMARY:/b/ppspanThe primary purpose of this position is to provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements. The prior authorization nurse will promote the quality and cost effectiveness of patient care using clinical acumen. Assesses applications for specific treatments, medical procedures, equipment, and medications. Review each request for medical coverage and determine the necessity or potential benefits of the treatment or medicine. Assess patient information and other factors to decide whether or not to authorize coverage. Additionally, the nurse will prepare documentation, perform audits of patient records, and assist management as needed./span/pp/ppbSPECIFIC RESPONSIBILITIES:/b/pulliPerform clinical reviews of authorization requests using appropriate criteria for medications and durable medical equipment/liliProvide accurate and complete documentation with rationale used to approve request/liliCollaborate with various staff within provider networks and case management teams/liliAbility to multitask between computer and phone requests/liliParticipate in interdepartmental projects when needed/liliEnter and maintain clinical information in electronic health record/liliWork triage in boxes as needed/lilispanParticipate in daily huddles with patient care team(s) as needed/span/lilispanReview and triage medication refill requests/span/lilispanParticipate in annual competency training of clinical staff/span/lilispanSupports the prior authorization needs of the Internal Medicine and Psychiatry departments as needed/span/li/ulp/ppiThis role description is a general description of the essential job functions.  It is not intended to describe all the duties the /iiPrior Authorizations RN/i imay perform./i/pp/ppbKEY COMPETENCIES:/b/pp/pullibCommunication Skills /b/li/ulpEffectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families./pp/pp/pullibDecision Making/b/li/ulpAbility to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time./pp/pp/pullibHealthCare Knowledge/b/li/ulpHaving the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate.  This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC’s organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate./pp/pp/pullibInterpersonal Skills /b/li/ulpShowing the ability to meet difficult situations with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when its most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others./pp/pp/pullibOrganizational Values/b/li/ulpAdherence to MAHEC’s founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and equitable practices, ability to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need./pp/pp/pullibProblem Solving /b/li/ulpHaving an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically through a difficult problem and come to an appropriate resolution for a given issue. This helps to drive continuous improvement by thinking through where we can improve in a novel way. Measures success by understanding where we are currently and where we want to go and then applying those new ideas to affect positive change./pp/ppbSPECIFIED SKILLS/b/pulliiCOMPUTER/iulliExcellent skills in Microsoft Office including Word, Excel, PowerPoint, and database applications required./liliKnowledge and experience documenting patient care in an electronic health record/li/ul/liliiFOREIGN LANGUAGE/iulliSpanish speaking skills preferred./li/ul/liliiOTHER/iulliKnowledge and experience with Medicare, Medicaid, and commercial payers/li/ul/li/ulp/ppbPHYSICAL DEMANDS/b/pulliNot Applicable./li/ulp/ppbSUPERVISORY RESPONSIBILITIES:/b/pp/ppbEDUCATION AND EXPERIENCE/b/pulliiMINIMUM QUALIFICATIONS:/iulliBachelors Degree in Nursing/li/ul/liliiPREFERRED QUALIFICATIONS:/iulliTwo (2) years relevant experience or comparable combined experience and/or education./liliOne (1) to two (2) years of nursing experience in an ambulatory setting./li/ul/li/ulp/ppbREQUIRED LICENSES:/b/pulliCurrent unencumbered North Carolina nursing license/liliCurrent CPR certification/li/ulp/ppbSCHEDULE:/b/ppRegular attendance on-site is an essential function of this position. Typical business hours are Monday – Friday, 8:00 am to 5:00 pm (or flexed to best meet the needs of the clients and/or the Division); 40 hours per workweek; weekend, holiday, or evening coverage is occasionally required. Work hours will need to be flexible in order to respond to special work assignments, or evening activities, as requested by the team leader./pp/ppbspanPOSITION COMPENSATION:/span/b/ppspan$33.32/hour, full time with full benefits available/span/pp/ppAt MAHECb, /bwe strive to equip all team members with Total Rewards (pay #43; benefits) to honor their service, support their health, manage their financial security, build their career, and thrive./pp/ppAll MAHEC employees and learners will be required to receive the Flu vaccine or have an approved exemption./pp/ppMAHEC Talent Management is located at 121 Hendersonville Road, Asheville, NC 28803. Equal Opportunity Employer./pp/ppspanMAHEC is a qualifying employer for the Public Service Loan Forgiveness (PSLF) Program. Employees who meet federal requirements may be eligible to have remaining student loan balances forgiven after 10 years of qualifying payments while working full-time at MAHEC./span/pp/ppspanIf you are interested in this role, and you have related experience and qualifications, we encourage you to apply or reach out to a href="mailto:AskTalent#64;mahec.net" target="_blank"AskTalent#64;mahec.net/a/span for support in your job search process. You could be the talent we are seeking for this or other opportunities./pp/p