Pre-Authorization Nurse |
| Oct. 21, 2009 - Oct. 21, 2010 |
| Location: | St. Petersburg, FL |
| Exempt/Non-Exempt: | Exempt |
| Employment Type: | Full Time |
| Department: | Utilization Management |
| Description: | To provide quality care while utilizing cost effective measures. To review clinical data, investigate resources, and conduct pre-service determinations by applying criteria to determine medical necessity within regulatory timeframes given by InterQual, Medicare and Medicaid.
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| Duties: | Participate in daily preauthorization meetings.
Act as a patient advocate by seeking and coordinating solutions to patients' health care needs without compromising the quality of outcomes.
Under the direct supervision of the Preauthorization Supervisor, the Preauthorization Nurse coordinates the delivery of services to members while adhering to the policies and procedures of the Utilization Management Department.
Refer members to Case and Disease Management programs as appropriate
Serve as resource person for case managers, physicians, members/families and other health care professionals
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| Qualifications: | Possession of an unrestricted LPN/LVN in the State of Florida is required
An equivalent combination of education and experience from with comparable knowledge and abilities can be obtained is necessary. One to two years of experience in an area of specialization is necessary
Knowledge of Interqual and Medicare/Medicaid regulations preferred
Familiar with and follows accepted standards of practice through the use of evidence based medical principles, standards and practices
Strong organizational, time management and interpersonal skills
Strong ability to multitask and prioritize
Ability to maintain emotional stability to cope with emergencies and other stresses
Ability to prioritize referral requests using nursing assessment skills
Knowledge of the nature and treatments of diseases and of reactions and side effects of related therapy methods
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