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Form of work
SalaryJOB SUMMARY
The Prior Authorization/Utilization Review Nurse is responsible for carefully recording information regarding patient care on the back end of the clinic and doctor's office visits in hopes of keeping healthcare costs low for both patients and the organization.
ESSENTIAL JOB FUNCTIONS
Ensure the highest quality of patient care through systematic reviews of the patient's medical records and active communication with the patient, family members, and healthcare teams.
Reviews and makes decisions about the appropriateness and level of patient care being provided.
Ensures patients receive necessary care without performing unnecessary or duplicate services.
Must have understanding of most common disease processes and associated medications.
Ability to extract relevant clinical information to satisfy payer source requirements for reimbursement.
Must be able to track and follow-up on multiple cases at a time.
Work closely with pharmacy, providers, and accounts receivable to close the loop on unpaid pharmacy claims.
Ensure accurate and timely documentation of calls and to return calls in a timely manner.
Each recommendation must be evaluated carefully to ensure that every patient receives the care they need. Case determinations should include clear evidence to support the recommendation.
Other duties as assigned.
High School diploma or equivalent.
Completion of an accredited RN program. Current and valid Oklahoma RN license.
3+ years of clinical experience preferred.
BLS CPR Certification.
Intermediate computer skills.
Strong communication skills.
Utilizing a patient-centered, multidisciplinary, medical home approach, Indian Health Care Resource Center, a 501(c)(3) nonprofit organization, offers a full range of health and wellness services tailored to the Indian community.
MISSION
The mission of the Indian Health Care Resource Center of Tulsa, Inc. (IHCRC) is to provide quality, comprehensive health care to Tulsa area Indian people in a culturally sensitive manner that promotes good health, well-being and harmony.
VISION
The vision of IHCRC is to eliminate health disparities, expand innovative family-focused practices and promote an embracing approach to care that strengthens physical, mental, emotional and spiritual wellness within the Indian community.
HEALTH PROMOTION AND DISEASE PREVENTION GOAL
The long-term goal of IHCRC is to improve general health status and reduce the incidence and severity of chronic disease by engaging the Indian community in ongoing health promotion, and disease prevention and management programs.
