Rn Prior Authorization Specialist

**$1,000 Sign-On Bonus**

CAREER OPPORTUNITY

Job Title: Registered Nurse (RN) - Prior Authorization Specialist

ABOUT FIVE RIVERS HEALTH CENTERS

The Five Rivers Health Center is an expanding Federal Qualified Health Center located in Dayton and Xenia, Ohio providing a medical home for low-income patients. Our growing organization empowers staff to make a difference every day in the lives of others and is committed to provide quality, cost-effective care for our patients and community, with respect and dignity, without regard of ability to pay.

Five Rivers Health Centers values all persons regardless of sexual orientation, gender identification or expression of either. Five Rivers Health Centers takes pride in building a team that brings together diversity of thoughts, perspectives and expressions while serving our patients.

Position Overview

To support the mission and vision of Five Rivers Health Center by integrating the nursing process through patient history, planning, implementation, and evaluation resulting in coordination and delivery of care. The Registered Nurse - Prior Authorizations will assist patients with medication needs, Prior Authorization functions, notification of coverage, and finding coverage alternatives.

General Responsibilities

• Communicates with patients to obtain information required to process prescriptions, refills, access benefits and coverage.
• Obtains Prior Authorizations; initiates requests, tracks progress, and expedites responses from insurance carriers and other payers while maintaining contact with patients and keeping them informed on the process.
• Reviews for accuracy of prescribed treatment regimen prior to submission of authorization.
• Facilitates appeal process between the patient, physician, and insurance company; composes clinical appeal letters based off of denial reason and patient's clinical presentation.
• Tracks, reports and escalates service issues arising from requests for authorizations, financial assistance or other issues that delay service.
• Documents case activity, communication, and correspondence in computer system to ensure completeness and accuracy of patient contact records.
• Per provider instructions and clinic policies, performs medication refills, gives directives to patients, coordinates transfer of prescriptions, and gives diagnostic results to patients.

Qualifications

• Graduation from an accredited school of nursing required
• Registered Nurse License in the state of Ohio required
• 3+ years of experience including experience in an office setting preferred.

Benefits

Five Rivers Health Center offers a complete benefits package including medical insurance, dental insurance, vision insurance flexible spending accounts, health savings accounts, paid holidays, paid vacation & sick days, short-term disability, long-term disability, life insurance, wellness incentives, department incentives, and 401(k).

EOE/M/F/D/V

Job Type: Full-time

Pay: From $27.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Medical specialties:

• Primary Care

Physical setting:

• Clinic
• Community health center

Standard shift:

• Day shift

Supplemental pay types:

• Bonus opportunities
• Quarterly bonus
• Retention bonus
• Signing bonus

Weekly schedule:

• 5x8
• Monday to Friday

Application Question(s):

• Please provide requested salary:

License/Certification:

• graduation from an accredited school of nursing (Required)
• Registered Nurse License in the state of Ohio (Required)

Ability to Relocate:

• Dayton, OH 45417: Relocate before starting work (Required)

Work Location: In person