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Prior Authorization Specialist - Nephrology Clinic

Job Overview

Prior Authorization Specialist

Position is for the Nephrology Clinic location

Grand River Medical Group is seeking an ambitious nurse (LPN, RN) to work as a Prior Authorization Specialist in our Nephrology Clinic. As a Prior Authorization Specialist, you will be responsible for obtaining prior authorization approvals for various procedures and services including but not limited to medical, elective, ancillary, and pharmaceutical. You will work closely with insurance companies and health plans to obtain prior authorizations for patients at Grand River Medical Group.

The ideal candidate would be detail oriented, self-motived and work independently or part of a team. You will be responsible for prioritizing your workload and being able to multi-task while continuing to provide an exceptional patient experience.

This is a full-time position, 36-40 hours per week. This position is typically 4 days per week, with no evening or weekend requirements. All nursing positions have the ability to pick up shifts at other clinic locations as desired. Grand River Medical Group's clinics are typically open from 7:30 a.m. - 5:00 p.m.

Duties include but are not limited to:

• Initiate prior authorization process by processing clinical requests requiring medical review of the patient's electronic chart.
• Review prior authorization requests and communicate with the healthcare team when additional information is needed.
• Contact appropriate insurance carrier to obtain prior authorization approval number.
• Handle all requests for prior authorizations in a timely and accurate manner.
• Maintain a thorough understanding of authorization requirements and health plan contracts.
• Provide nursing care by using the nursing process and theory in assessing patient's general condition and in making clinical decisions.
• Prepare patients for clinician office visit, including greeting and escorting to exam room, obtaining vitals, updating medications and allergies in electronic medical record, and explaining procedures.
• Assist the clinician with examinations, diagnostic procedures and treatments.
• Document accurately in all areas of the electronic medical record.

Education/Experience/Skills:

• Must be a graduate from an accredited school of nursing for Licensed Practical Nurses or Registered Nurses.
• Minimum three years of professional nursing experience in a clinic setting preferred.
• Must be a licensed LPN or RN with an active license to practice in the state of Iowa; BSN preferred.
• Prior Authorization experience preferred.
• Basic Life Support (BLS) certification required.

We offer: A competitive hourly wage plus a very attractive benefits package including vacation, generous company provided benefits, and much more.

Grand River Medical Group is an independent physician owned practice located in Dubuque, IA. We provide a wide range of healthcare services from primary care to subspecialty care for adults and children. We currently employ over 300 team members who help support the practices and clinical operations of over 65 physicians, nurse practitioners and physician assistant clinics, our urgent care network, and four dialysis units located in Iowa (Manchester and Dubuque) and Wisconsin (Platteville and Richland Center).

Grand River Medical Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, religion, color, national origin, sex, age, sexual orientation, gender identity or expression, status as a protected veteran, or status as a qualified individual with disability.