Prior Authorization Nurse

Prior Authorization Nurse 2.4 2.4 out of 5 stars 125 South 20th Street, Paducah, KY 42003 Full-time KentuckyCare 7 reviews

Full-time Job Title:

Prior Authorization Nurse Job Type:

Full-time (Monday-Friday, 8:00 AM - 5:00 PM)

Travel:

0-15%

Qualifications:

Current LPN or RN license in the required state Completion of an accredited LPN or RN program Experience with prior authorizations preferred Proficient in Microsoft Office and electronic medical record systems Strong clinical judgment and organizational skills

Job Summary:

Discover a rewarding career at Arcare. We are seeking a detail-oriented, efficient, and patient-focused Prior Authorization Nurse to join the Arcare team. In this role, you will be responsible for reviewing and processing authorization requests to ensure compliance with national standards and contractual requirements. The Prior Authorization Nurse plays a key role in supporting the delivery of cost-effective and high-quality patient care by leveraging clinical expertise and effective communication. In addition to managing authorization processes, the Prior Authorization Nurse will assist the clinical team with direct patient care services and nursing tasks as needed. This role is ideal for a licensed nurse with a passion for ensuring seamless access to care while maintaining high standards of clinical excellence. Reasonable Accommodations To perform this job successfully, an individual must be able to satisfactorily perform each essential duty. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Key Responsibilities:

Review prior authorization requests in a timely and accurate manner Ensure requests meet national standards, contractual requirements, and clinical guidelines Collaborate with healthcare providers to collect necessary documentation and support efficient processing Promote cost-effective care while ensuring quality standards are met Assist the clinical team with direct patient care services and designated nursing tasks when needed Maintain accurate records and documentation in electronic medical systems Communicate effectively with patients, providers, and healthcare teams to resolve authorization-related issues Adhere to all organizational policies, procedures, and professional standards Participate in team meetings, training sessions, and professional development opportunities

Skills & Attributes:

Strong clinical acumen and ability to make sound decisions based on patient needs and guidelines Excellent organizational and time-management skills Strong communication and interpersonal skills to work effectively with patients, providers, and colleagues Ability to handle sensitive information with confidentiality and professionalism A proactive and collaborative team player with the ability to work independently when needed

Company Paid Benefits:

Health, dental, and vision insurance Paid time off (sick and vacation, up to 96 hours accrued annually) Eight (8) paid holidays One (1) floating holiday One (1) birthday holiday Life insurance Long-term disability Free ARcare clinic benefits for employees with ARcare health insurance Retirement plan (401(k) with company matching up to 200% of 4% after 1 year of employment) Additional supplemental and family coverage available Travel Reimbursement In-house required trainings and recertifications CEU/CME allowance/reimbursement

Application Assistance:

If you need assistance with the application process, please email humanresources@arcare.net.

Equal Opportunity Employer:

Arcare is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by law. #IND2