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RN-Authorization Nurse

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If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.

Responsible for coordinating and monitoring the authorization and denials management processes. Serves as a liaison between ordering and referring physicians, insurors, patient financial services, case management, HIM, PAS, surgery and diagnostic departments, and patients while evaluating clinical criteria to obtain authorization to secure successful payment for procedure(s) performed within the MLH system. Monitors and reports identified certification and payer issues, researches denials to identify patterns, then educates physician practice staff to assure successful claims submission and payment. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview
Responsible for coordinating and monitoring the authorization and denials management processes. Serves as a liaison between ordering and referring physicians, insurors, patient financial services, case management, HIM, PAS, surgery and diagnostic departments, and patients while evaluating clinical criteria to obtain authorization to secure successful payment for procedure(s) performed within the MLH system. Monitors and reports identified certification and payer issues, researches denials to identify patterns, then educates physician practice staff to assure successful claims submission and payment. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

Manages Authorization process to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.
Identifies, monitors and reports problematic areas in the certification process, which may impact registration, billing, and reimbursement.
Manages and researches denials. Coordinates denials management with physician practices & throughout MLH.
Actively participates in Methodist CIP efforts; identifies and communicates areas for improvement in ongoing efforts for quality care; assists in gathering, analyzing, and presenting data in the assigned populations.
Demonstrates initiative in identifying and pursuing opportunities for self-improvement and enhancement of professional competency.
Demonstrates effective customer relation skills, promotes a positive work environment, and contributes to the overall team effort. Establishes a good working relationship with physicians, clients, and other members of the health care team.
Understands, applies, and supports department/hospital policies, procedures, and standards.
Performs other job functions as requested or assigned.

Education/Formal Training Requirements

Associate's Degree Nursing- RN
Bachelor's Degree Nursing- RN

Work Experience Requirements

Authorization or Denials Management
Care Coordination
Case Management
5-7 years Clinical nursing

Licenses and Certifications Requirements

Case Manager - The Commission for Case Manager Certification
Registered Nurse Arkansas - Arkansas State Board of Nursing
Registered Nurse Mississippi - Mississippi Board of Nursing
Registered Nurse Tennessee - Tennessee Board of Nursing

Knowledge, Skills and Abilities

Positive working relationship and excellent interpersonal skills in working with physicians required.
Excellent written and verbal communication skills.
Ability to plan and schedule tasks and to maintain control of own work flow.
General PC skills.
Ability to communicate information to groups of people in an educational setting.
Effective interpersonal relationship skills.

Supervision Provided by this Position

There are no lead or supervisory responsibilities assigned to this position

Physical Demands

Non-invasive patient contact.
Must be able to read, write, and communicate both orally and in writing to individuals in the healthcare field.
Normal or corrected-to-normal vision.
Must have good balance and coordination.

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.

Average salary estimate

$70000 / YEARLY (est.)

min

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$60000K

$80000K

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What You Should Know About RN-Authorization Nurse, Methodist Health

Join the compassionate team at MLH as an RN-Authorization Nurse! In this pivotal remote role from Tennessee, you’ll be at the heart of healthcare coordination, making a significant difference in the lives of patients. If you’re someone who thrives on collaboration, you'll love being the liaison between various professionals including physicians, insurers, and patient financial services. You'll utilize your clinical expertise to manage authorization and denial processes, ensuring that patients receive the care they need while navigating complex insurance landscapes. You'll have the incredible opportunity to analyze denial patterns, educate physician practice staff, and improve claims submissions. With MLH, we’re not just about healthcare; we’re a community committed to excellence, compassion, and continuous improvement. Each day brings fresh opportunities to not only advance clinical processes but to grow your career within a supportive environment that values teamwork and individual contributions. If you’re eager to apply your nursing experience and make a true impact on patient care, then the RN-Authorization Nurse position is the perfect fit for you! Our culture is built on unity and the shared goal of delivering the highest standards of care. Together, we can carry forward our mission of serving the health care needs of Memphis and the Mid-South. At MLH, we believe in the Power of One, and with your talent, we can create a brighter future for our community.

Frequently Asked Questions (FAQs) for RN-Authorization Nurse Role at Methodist Health

What are the key responsibilities of the RN-Authorization Nurse at MLH?

The RN-Authorization Nurse at MLH plays a crucial role in managing the authorization process for medical care. This includes coordinating with various healthcare departments, evaluating clinical criteria for patient procedures, and ensuring successful payment through effective denials management. The nurse serves as a vital liaison among physicians, insurers, and patients, promoting quality and cost-effectiveness in care.