RN-Prior Authorization / Referral Procedure and Insurance Coordinator

Overview

Join Our Growing Hematology / Oncology Team!

UnityPoint Health - John Stoddard Cancer Center is expanding! We're proud to announce the opening of a new medical oncology and hematology clinic , along with expanded chemotherapy infusion services , all located at our flagship center at 1221 Pleasant St., Des Moines .

This exciting growth includes the addition of three medical oncologists and two nurse practitioners , and we're looking for compassionate, skilled Registered Nurses to join our team and help deliver exceptional, specialized cancer care to Central Iowa.

RN, Prior Authorization / Referral / Procedure and Insurance Coordinator functions as a clinician, educator and resource for patients within their specialty of care and up to their licensure in scope of practice. Facilitates all facets of the patient referral process and pre-authorization of insurance payments prior to appointments.

Why UnityPoint Health?

At UnityPoint Health, you matter. We're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.

Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you're in. Here are just a few :

• Expect paid time off, parental leave, 401K matching and an employee recognition program .
• Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.
• Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family .

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.

And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.

Find a fulfilling career and make a difference with UnityPoint Health.

Responsibilities

Patient Care, Education and Clinical Support

• Coordinates and develops ongoing patient care, including appointments, communication, and instruction.
• Function as a clinician, educator and resource for patients within their specialty of care.
• Assist provider and clinical staff with patient prep for examinations, treatments, and minor clinic procedures.
• Delivers high quality care utilizing the nursing process while demonstrating knowledge and clinical skills in accordance with established policies, procedures, and standards of care throughout the clinic and across the health care continuum.
• Maintain flexibility by demonstrating an ability and willingness to perform a variety of duties and accept changes or additions to assignments.
• Thoroughly understand testing (lab and procedures) values and relationship to patient status with accountability to take next steps, as appropriate to scope and licensure.
• Utilize critical thinking in making independent judgements and maintains responsibility and accountability for the knowledge of conditions of assigned patients.
• Builds and maintains positive working relationships with patients, physicians, and all others.
• Perform other duties as requested by Manager of Oncology Services to facilitate the smooth and effective operations of the hosp / clinics.
• Maintains knowledge of clinical protocols to facilitate timely and complete work up of patients.

Care Coordination / Precertification and Prior Authorization Certification

• Obtain necessary pre-authorization requirements for office, clinic / hospital studies / procedures, diagnostic testing, and imaging for patients as ordered by physicians.
• Work closely with clinical department and physicians to provide additional information when nurse review or peer-to-peer requests are made by the insurance carrier.
• Maintains current knowledge of patients' insurance carriers as well as payer specific requirements of prior authorizations by attending virtual workshops, researching, reading newsletters.
• Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner.
• Coordinates appointments, forms and requisitions and relays timely authorization information to scheduling staff.

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
• Demonstrates ability to meet business needs of department with regular, reliable attendance.
• Employee maintains current licenses and / or certifications required for the position.
• Practices and reflects knowledge of HIPAA, DIA, OSHA and other federal / state regulatory agencies guiding healthcare.
• Completes all annual education and competency requirements within the calendar year.
• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Qualifications

Education :

• Graduate of an accredited school of nursing or IA Board of Nursing approved nursing program.
• BSN degree preferred

License(s) / Certification(s) :

• Current licensure in good standing to practice as a Registered Nurse in Iowa
• Valid driver's license
• Basic Life Support (BLS) ceritification or obtain certification within three months from date of hire
• Mandatory Report Certification

Experience :

• Two (2) years of RN experience.
• Experience in the oncology setting preferred
• Experience with insurance verification / pre-authorizations preferred

Other :

• Level 3 Medium Work : Exerting up to 50 pounds of force occasionally, and / or up to 20 pounds of force frequently, and / or up to 10 pounds of force constantly to move objects.