Prior Authorization Nurse Job Description

Position Roles and Responsibilities

As a prior authorization nurse, one will be required to;

Carry out reviews of all non-urgent requests from all departments.

Assist UR and IP nurses in authorizing specific medications, treatments, and minor surgeries in the absence of the UR nurse.

Review non-urgent medical records and documents and develop a filing system to enable ease of access and sharing across the department on request.

Collect evidence on all requests before authorization. Ensure that all non-requests are delivered as required. Evidence is an essential component of managerial decision-making and influences the quality, efficacy, and effectiveness of hospital services (Janati et al., 2018).

Apply one’s nursing capacity to further review the non-urgent requests and identify any such requests that may be deemed urgent. In addition, the authorization nurse should communicate such urgency to the UR and IP nurses.

Review payer documentation to determine authenticity and communicate with the insurance providers for authentication or collect more information on the patient if needed.

Ensure that all requests meet the facility’s policies and the basic patient-insurance provider contractual agreement before authorization.

Provide training and development support to users on services and benefits utilization and related processes.

Provide timely authorizations to ensure that patients receive optimal and timely care as needed.

Provide support to the UR and IP nurses to improve the efficiency of health care services and benefits utilization.

Act as an intermediary between the clinical staff and non-clinical staff.

Basic Qualifications

Be a registered nurse and licensed,

Possess an Associate’s Nursing degree or ongoing training from an accredited institution.

Have a minimum of 3 years of experience in a similar position or healthcare setting.

Possess basic knowledge of utilization management processes, managed care, and utilization management principles.

Proficiency in information management.

 References

Janati, A., Hasanpoor, E., Hajebrahimi, S., & Sadeghi-Bazargani, H. (2018). Evidence-based management–healthcare manager viewpoints. International journal of health care quality assurance.

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During this course, you will develop materials that support the human resource process of acquiring, developing, and leveraging employee strengths. This project is broken into four separate assignments due in Topics 2, 3, 5, and 7.

Acquiring Employees and Department and Employee Needs Assessment

In this assignment, conduct a needs assessment and develop a job description for your current organization or a preapproved organization that you have access to interact with. If you are not currently in an organization, inform your instructor of the organization you will use to complete this project. They must approve your selection prior to beginning your assignment, and you must have the ability to observe employees and functions within that organization.
Needs Assessment
Observe and assess the state of your current organization or another pre-selected organization. A needs assessment is necessary to identify areas for potential growth, both at the employee and organizational level. If you are not in a position to look holistically at your organization, you can focus on a department or team within the organization. Use the “Needs Assessment Matrix” to complete your needs assessment. You are required to analyze required functions, department or employment needs, jobs or tasks, and current training in order to complete your matrix and prepare for the next part of this assignment.
Job Description
Once your needs assessment is complete, you are required to select an existing position in your organization and develop a one-page detailed job description for that position that is informed by the findings of the needs assessment. It is recommended that you take the time to conduct a job analysis and observe current employees in the selected positions to accurately depict the knowledge, skills, abilities, and other characteristics that must be incorporated into the job description. If you are unable to observe, do your best to accurately depict the specific functions of the job. Incorporate any new job roles you feel should be added to the position based on your findings. Make sure the job description is based on the needs and available resources of the organization and that it adheres to all applicable labor laws.
Submit the “Needs Assessment Matrix” and the one-page job description as two deliverables.
APA format is not required, but solid academic writing is expected.