Prior Authorization Nurse - LPN

1.0 FTE (40 hrs/wk); Monday - Friday, business hours. This position requires initial on-site training, and then will transition to a fully remote role once training is completed. On-site training will be located at the 455 Phalen location in St. Paul. This is a remote opportunity; however, the selected candidate must reside in Minnesota or Wisconsin and have the ability to work onsite in St. Paul, MN as needed

Licensure through the MN Board of Nursing is required along with a minimum of one year nursing experience in a healthcare environment.

Purpose of Position:

This position exists to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to the request for prior authorization.

Specific duties are determined by the work setting or patient population served; however, in all positions, serving patients with challenging and complex conditions requires a concentration of specialized staff able to work in highly coordinated teams. We organize care around each patient’s condition which requires staff at multiple levels and across many departments to exhibit exceptional teamwork qualities including communicating efficiently and effectively and adopting the behaviors required for high functioning integrated teams, consistent with our Gillette CARES expectations.

Compensation and Benefits Information: 

The hourly wage for this opportunity is $23.98 to $35.97, with a median wage of $29.97/hour. Pay is dependent on several factors including relevant work experience, education, certification & licensure, and internal equity. Hourly pay is just one part of the compensation package for employees. Gillette supports career progression and offers a competitive benefits package that includes a retirement savings match, tuition and certification reimbursement, paid time off, and health and wellness benefits for .5 FTE and above.

Core Responsibilities and Duties:

• Perform the processing of authorizations, certifications and referrals needed from payers in order to allow reimbursement at the highest levels for both the patient and for the organization.
• Utilize available resources for checking patient insurance benefits and eligibility to determine prior authorization requirements, and to better inform our patients of their estimated financial liability.
• Must abide by all Joint Commission requirements including, but not limited to, sensitivity to cultural diversity, patient care, patients' rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
• This position is responsible for maintaining professional and ethical behavior at all times as outlined by licensing guidelines and company policies.

Qualifications:

Required:

• Minimum licensure as a Licensed Practical Nurse (LPN) from the MN Board of Nursing is required. Candidates/incumbents with a valid MN Registered Nursing (RN) License are qualified for this position as well. 
• Documentation of completion of a practical nursing program (LPN program)
  • If candidate holds a RN license instead of LPN license, documentation of RN education program is required.
• Knowledge of pharmacy, pharmaceuticals or healthcare business.
• Minimum one year of nursing experience in a healthcare environment

Preferred:

• Active professional affiliations and /or national certification related clinical specialty preferred

Knowledge, Skills & Abilities:

• Knowledge of Payer requirements and expectations regarding prior authorization
• Knowledge of pharmacy, pharmaceuticals, or healthcare business.
• Familiarity with CPT/HCPCS and ICD-10
• Ability to proficiently analyze and interpret clinical criteria
• Works effectively across organization and fosters teamwork
• Demonstrates the ability to utilize resources while building strong credible working relationships with clients, patients and internal partners
• Demonstrated excellent customer service and communication skills – verbal, written, and listening.
• Demonstrated knowledge of medical terminology
• Proficient technology skills, including working with a computer (PC) using Microsoft Office Products, databases and other programs.
• Must demonstrate ability to work independently with analytical, problem-solving and decision- making.

 

At Gillette Children’s, we foster a culture where every team member feels a sense of belonging and purpose. We are dedicated to building an environment where all feel welcomed, respected, and supported. Our values are embedded at the heart of our culture. We act first from love, embrace the bigger picture, and work side-by-side with our patients, families, and colleagues to help every child create their own story. Together, we work to ensure patients of all backgrounds and abilities reach their full potential.

Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws.

Gillette Children’s is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses.

To learn more about working at Gillette Children's, please visit https://www.gillettechildrens.org/careers.

 

Gillette Children's participates in the U.S. Department of Homeland Security (DHS) E-Verify program which is an internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. If E-Verify cannot confirm that you are authorized to work, Gillette will give you written instructions and an opportunity to contact DHS or the Social Security Administration (SSA) to resolve the issue before Gillette takes any further action. Please visit https://www.e-verify.gov/ for further details regarding e-verify.