prior authorization nurse

Blue Cross Blue Shield of Arizona

<div>
 Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
 
 
 At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
 
 
 <ul>
 <li>
 Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
 </li>
 <li>
 Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
 </li>
 <li>
 Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
 </li>
 <li>
 Onsite: daily onsite requirement based on the essential functions of the job
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 Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
 
 
 </li>
 </ul>
 Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
 
 
 
 This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
 
 
 
 
 PURPOSE OF THE JOB
 
 
 
 Ensures accuracy and timeliness in the completion of prior authorization (PA) requests to meet contractual requirements and ensures all reviews utilize nationally recognized and evidence-based standards for the Medicaid Segment which includes Medicaid and Medicare Advantage / Dual Eligible Special Needs Plan (D-SNP), and Affordable Care Act (ACA) members. Ensures the completion, accuracy, and timeliness in the Notice of Action (NOA) process.
 
 
 
 Qualifications
 
 
 
 
 REQUIRED QUALIFICATIONS
 
 
 
 
 Required Work Experience
 
 
 
 <ul>
 <li>
 3 years of clinical experience
 </li>
 <li>
 1 year of Medicaid/Medicare experience
 </li>
 <li>
 1 year prior authorization and member and provider notification (NOA) experience
 </li>
 <li>
 1 year experience with National Committee for Quality Assurance (NCQA) standards
 
 
 </li>
 </ul>
 
 Required Education
 
 
 
 <ul>
 <li>
 Associate degree in Nursing
 
 
 </li>
 </ul>
 
 Required Licenses
 
 
 
 <ul>
 <li>
 Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including RN or LPN.
 
 
 </li>
 </ul>
 
 Required Certifications
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 
 Preferred Work Experience
 
 
 
 <ul>
 <li>
 3+ years of experience in managed care
 </li>
 <li>
 3+years of experience in prior authorization/utilization review
 
 
 </li>
 </ul>
 
 Preferred Education
 
 
 
 <ul>
 <li>
 Bachelor of Science in Nursing
 
 
 </li>
 </ul>
 
 Preferred Licenses
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Preferred Certifications
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Essential Job Functions And Responsibilities
 
 
 
 
 ALL LEVELS
 
 
 
 <ul>
 <li>
 Ensures the accuracy and timeliness of prior authorization requests to meet contractual requirements.
 </li>
 <li>
 Coordinates and manages the established preauthorization review process for pre-service requests.
 </li>
 <li>
 Ensures the use of nationally recognized and evidence-based standards in the completion of all pre-service reviews.
 </li>
 <li>
 Utilize clinical skills, chart review, physician communication and appropriate criteria for approval of pre-service requests; escalate pre-service request(s) to the medical director for determination when criteria not met.
 </li>
 <li>
 Clearly define and document review rationale to support approval, Medical Director Review and/or Notice of Action document.
 </li>
 <li>
 Initiates interdepartmental coordination to ensure quality and timely care for members.
 </li>
 <li>
 Participates in Quality Improvement Projects as directed.
 </li>
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 Participate in department audits and other regulatory activities.
 </li>
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 Engage cross-functionally and participate in special projects as needed.
 </li>
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 Performs Notice of Action (NOA) process.
 </li>
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 Participate in annual policy and procedure review and revision.
 </li>
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 Perform all other duties as assigned.
 </li>
 <li>
 The position requires a full-time work schedule,40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
 
 
 </li>
 </ul>
 
 COMPETENCIES
 
 
 
 
 Required Competencies
 
 
 
 
 Required Job Skills
 
 
 
 <ul>
 <li>
 Computer skills to include Microsoft Office applications, Word, Excel, and Outlook
 </li>
 <li>
 Ability to use electronic medical management systems
 </li>
 <li>
 Analytical problem solving skills
 
 
 </li>
 </ul>
 
 Required Professional Competencies
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Required Leadership Experience And Competencies
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Preferred Competencies
 
 
 
 
 Preferred Job Skills
 
 
 
 N/A
 
 
 
 Preferred Professional Competencies
 
 
 
 N/A
 
 
 
 Preferred Leadership Experience And Competencies
 
 
 
 N/A
 
 
 
 Our Commitment
 
 
 
 AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
 
 
 Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
</div>

Prior Authorization Nurse - Remote - AZ

Jawa Health Care

Job SummaryThe Prior Authorization Executive is responsible for obtaining pre-approvals from insurance companies for medical procedures, treatments, and medications. This role ensures timely authorization to avoid delays in patient care and reimbursement while maintaining compliance with payer guidelines.Key Responsibilities<ul><li>Initiate and process prior authorization requests via portals, phone calls, or fax</li><li>Verify patient insurance eligibility and benefits before submission</li><li>Review patient records, clinical documents, and physician orders</li><li>Submit accurate authorization requests with required medical documentation</li><li>Follow up with insurance companies for pending approvals</li><li>Handle denials and initiate appeals with proper justification</li><li>Maintain accurate records of all authorization activities</li><li>Communicate authorization status with providers, patients, and internal teams</li><li>Ensure compliance with payer policies, CPT/ICD codes, and medical necessity guidelines</li></ul>Required Skills &amp; Qualifications<ul><li>Bachelor&rsquo;s degree (Healthcare Administration, Business, or relevant field preferred)</li><li>1&ndash;3 years of experience in Prior Authorization / Medical Billing / RCM</li><li>Strong knowledge of:</li><li>Insurance verification</li><li>Prior authorization process</li><li>Medical terminology</li><li>CPT &amp; ICD-10 coding</li><li>Excellent communication and coordination skills</li><li>Strong attention to detail and time management</li><li>Ability to work in a fast-paced, target-driven environment</li><li>Proficiency in MS Office and healthcare software (EMR/EHR systems)</li></ul>Key Competencies<ul><li>Analytical &amp; problem-solving skills</li><li>Multitasking ability</li><li>Strong follow-up and negotiation skills</li><li>Customer service orientation</li><li>Ability to meet deadlines and SLAs</li></ul>KPIs / Performance Metrics<ul><li>Authorization approval rate</li><li>Turnaround time (TAT)</li><li>First-pass success rate</li><li>Accuracy &amp; compliance</li><li>Daily productivity targets</li></ul>Working Conditions<ul><li>Night shift / US healthcare shift</li><li>Office-based</li></ul>Career Path<ul><li>Prior Authorization Executive</li><li>Senior Authorization Executive</li><li>Team Lead &ndash; Authorization</li><li>RCM Manager</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs60,000.00 per monthWork Location: In person

Prior Authorization Executive

Hazrin

Company DescriptionMedAlign Solutions LLC is a leader in delivering reliable medical billing, coding, and reimbursement solutions tailored for healthcare providers nationwide. Focused on accuracy and efficiency, we streamline the billing process, enabling healthcare professionals to prioritize patient care. Our certified team utilizes advanced technology and industry expertise to ensure timely claims submission, reduce denials, and optimize revenue cycles. With a commitment to personalized support, MedAlign Solutions provides transparent and high-quality services that enhance operational efficiency and help healthcare organizations succeed.Role DescriptionThis is a full-time on-site role for a Prior Authorization Specialist located in Islamabad. In this position, the specialist will manage and oversee the prior authorization process for medical services by reviewing documentation, verifying patient insurance coverage, coordinating with medical staff, and communicating effectively with insurance companies to ensure approval. Additional responsibilities include maintaining accurate records, resolving authorization issues, and staying updated on changes in insurance policies and procedures to ensure compliance.Qualifications<ul><li>Proficiency in handling Prior Authorization, Medical Billing, and Insurance Verification</li><li>Strong organizational and documentation skills to maintain accurate authorization records</li><li>Knowledge of medical terminology, coding, and healthcare regulations</li><li>Effective communication and problem-solving skills for liaising with patients, providers, and insurance companies</li><li>Attention to detail and the ability to manage a high volume of tasks efficiently</li><li>Experience with medical billing software and technology platforms</li><li>Bachelor's degree in healthcare, business, or related field preferred</li><li>Experience in prior authorization or medical billing is highly desirable</li></ul>Job Type: Full-timePay: Rs70,000.00 - Rs90,000.00 per monthExperience:<ul><li>Prior Authorization: 1 year (Preferred)</li></ul>Location:<ul><li>Islamabad (Preferred)</li></ul>Work Location: In person

Prior Authorization Specialist

Amerita, Inc

<div>
 
 Our Company
 
 
 
 Amerita
 
 
 
 Overview
 
 
 
 This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process.
 
 
 Shift: Monday-Friday 8:30am-5:30pm (CST)
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply, ensuring compliance with payer requirements and clinical guidelines.
 </li>
 <li>
 Collaborate with healthcare providers, insurance companies, and patients to gather necessary clinical information and documentation to support prior authorization submissions.
 </li>
 <li>
 Submit prior authorization requests accurately and in a timely manner, utilizing electronic submission platforms and following established protocols.
 </li>
 <li>
 Knowledgeable to perform all PA functions.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy
 </li>
 <li>
 1+ years pharmacy experience
 </li>
 <li>
 Pharmacy or healthcare-related knowledge
 </li>
 <li>
 Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication
 </li>
 <li>
 Basic math and analytical skills
 </li>
 <li>
 Intermediate typing/keyboard skills
 
 
 </li>
 </ul>
 
 About Our Line Of Business
 
 
 
 Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com . Follow us on Facebook , LinkedIn , and X .
 
 
 
 Additional Job Information
 
 
 
 
 Percentage of Travel:
 
 0-25%
 
 
 
 Salary Range
 
 
 
 USD $21.00 - $26.00 / Hour
</div>

Prior Authorization Specialist / Remote

Navani

<div>Base Pay Range:
Job Description:<h2 class="jobSectionHeader">
The Prior Authorization Specialist is a Full Time, Regular position working Monday-Friday 10:30am-7pm CST at the Navani Business Center, a wholly owned Inland Imaging company in Arlington, TX.</h2>
Summary: Prior Authorization Specialists are responsible for assisting patients, referring physicians and their staff in scheduling exams at an Inland Imaging Clinical Associates facility. The Prior Authorization Specialist provides support by processing Insurance verification and ensuring a pre-authorization is in place prior to an exam. The position requires a highly organized, motivated and a skilled problem solver. Attention to detail and strong customer service skills to ensure all necessary steps are taken to accurately identify or process a request for a prior authorization.
Essential Duties / Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.<ul><li>
Provides high quality customer service by:<ul><li>
Communicates by asking the appropriate questions to get information necessary to verify if an authorization is required and if so enough information to help process the request.</li><li>
Reviews and provides exam specific information as needed to ensure exam and authorization match.</li><li>
Completes phone call with a professional closing</li></ul></li><li>
Determines when an authorization/referral is required</li><li>
Obtains any information necessary to assist with the authorization process<ul><li>
Call patients and/or referring offices on self-pay accounts that may require prior authorization to identify the appropriate insurance.</li></ul></li><li>
Understands the billing process to identify and communicate the codes and forms that may be required to ensure reimbursement.</li><li>
Identifies and communicates any changes, when necessary, in the patient schedule, status (STAT), in-patient add-ons, etc. to appropriate parties</li><li>
Communicates with appropriate person for any follow-up needed on a patient exam.</li><li>
Identifies faxes from prior authorization fax server sent in by referring providers and renames with standard nomenclature</li><li>
Updates patient demographics as needed</li><li>
Adds and verifies patient current insurance information and verifies any changes indicated as part of the insurance look-up process on our internal system. Updates this information when needed.</li><li>
Keeps all on-line web portals accounts active to ensure access is maintained in order to obtain prior-authorization verification.</li><li>
Maintains a working knowledge of supplemental programs (Recondo and Payer websites)</li><li>
Demonstrates appropriate verbal and written communication skills to relay accurate information in a clear, concise manner to peers, staff, management, patients, guests, and medical staff.</li><li>
Initiates appropriate questions and provides timely feedback to lead and management on any issues, policies, and procedures, etc.</li><li>
Organizes and maintains records to provide accurate reporting, easy access to information and historical data.</li><li>
Coordinates patient care between technologists and clerical staff to facilitate a smooth workflow</li></ul><ul><li>
Acts as a liaison between staff, management, and physicians</li><li>
This position may be required to work in a hospital, urgent care or clinical setting.</li><li>
Responsible to be aware of assigned work rotations and monthly assignments</li><li>
Identifies and reports any updates to exam codes and CPT codes to Team Lead that may be encountered when working accounts.</li><li>
Identifies and reports any Payer updates or changes that may be encountered when working accounts to Team Lead.</li><li>
Identifies and reports any changes or updates to Payer web portals used in prior authorization process that may be encountered when working accounts to Team Lead</li><li>
Provides a Bi-weekly or monthly report out of identified issues or concerns regarding payers, system workflow or referring office items.</li><li>
Maintains the prior authorization resource portal by updating referring office contact information.</li><li>
Maintains the prior authorization issue log in smartsheet for tracking payer, billing, referring office or other issues to be reviewed and followed-up on by the Team Leader.</li><li>
Performs other duties as assigned.</li></ul> 
General Duties/Responsibilities:<ul><li>
Ability to maintain strict confidentiality within the Inland Imaging companies and Inland&rsquo;s customers.</li><li>
Follows all Health and Safety policies and guidelines of Inland Imaging, Navani or its partners depending on work location.</li><li>
Follows all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.</li><li>
Follows all policies regarding HIPAA, non-disclosure of confidential information and company security.</li><li>
Honest, pleasant manner and good personal hygiene.</li><li>
Free of alcohol and drug abuse.</li><li>
Valid state driver&rsquo;s license and proof of insurance.</li><li>
Excellent communication and interpersonal skills.</li><li>
Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.</li><li>
Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.</li><li>
Ability to consider individual needs in communication with and assessment and treatment of patients of all ages.</li></ul><ul><li>
Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.</li><li>
Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.</li><li>
Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities.</li><li>
Attendance is required for this position.</li><li>
Rotates to other shifts and locations as needed.</li></ul>
Supervisory Responsibilities:<ul><li>
There is no supervisory responsibility in this position</li></ul>
Advocacy:
Treats all patients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values<ul><li>
Show We Care, Do The Right Thing, Maximize Individual Potential, Challenge Convention</li></ul>
Qualifications:
<ul><li>Education: High School Diploma/GED required</li><li>
Experience: One year of previous scheduling, insurance or medical office experience required<ul><li>
Proficient and accurate with electronic health systems including applications of billing, pre-authorizations, demographics and coding preferred</li><li>
Anatomy and medical terminology preferred</li><li>
Medical office experience preferred</li><li>
Knowledge of coverage and requirements for private insurances, commercial insurance and government payers. Demonstrated experience using software applications for Electronic Medical Records preferred</li><li>
Understanding of procedures to be read by radiologist preferred</li></ul></li><li>
Computer Skills: Experience with the following computer applications is highly desired: Microsoft office products and a strong understanding of internet related access, Workday, Qgenda</li><li>
Background Check:<ul><li>
Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults</li><li>
In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Navani Health Solutions will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health &amp; Human Services, Office of the Inspector General (OIG). Employees must not be included on this list.</li></ul></li><li>
Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test including marijuana.</li></ul><h2 class="jobSectionHeader">
Nuvodia/Inland is an EEO employer...</h2></div>

Parkland Health

<div>Location: Parkland: 1st FLR BLK 400 
 
Advanced Practice Provider- Psychiatry (PRN)
 
 
Primary Purpose 
 
Responsible for providing health care for patients in designated primary or specialty areas, including patient diagnoses, treatment, education, and referrals. Serves as a resource and role model for clinical practice, training, evaluation, and direct management of practitioners and students in all areas encompassed by the service line to ensure optimal patient care quality. Assist leadership in assessing, planning, organizing, and implementing designated advanced practice provider activities. 
 
Minimum Specifications 
 
Education 
 
Physician Assistant 
<ul><li>
Bachelor's Degree from an accredited college or university and successful completion of an accredited Physician Assistant Program recognized by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or its predecessors.</li></ul> 

Advanced Practice Registered Nurse (APRN) 
<ul><li>
Master's Degree in Nursing accredited through the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing, Inc. (ACEN).</li></ul> 

Experience 
<ul><li>
2 plus years of clinical experience as an Advanced Practice provider (APP) in any field.</li></ul> 

Equivalent Education and/or Experience 
 
 
<ul><li>Current employees hired at Parkland prior to March 1, 2014, may have an equivalent combination of education and experience.</li></ul> 

Certification/Registration/Licensure 
<ul><li>
Must have a current healthcare provider BLS for Healthcare provider certification from one of the following:</li><li>
American Heart Association</li><li>
American Red Cross</li><li>
Military Training Network</li></ul> 

Must have a current certification from one of the following 
<ul><li>
Current certification in Advanced Cardiac Life Support (ACLS) must be obtained within 90 days of hire and maintained throughout employment.</li><li>
Current certification in Advanced Trauma Life Support (ATLS) must be obtained within 90 days of hire and maintained throughout employment.</li><li>
Current certification in Pediatric Advanced Life Support (PALS) must be obtained within 90 days of hire and maintained throughout employment.</li><li>
Current certification in Satori Alternative to Managing Aggression (SAMA) must be obtained within 90 days of hire and maintained throughout employment.</li><li>
Current certification in the Neonatal Resuscitation Program (NRP) must be obtained within 90 days of hire and maintained throughout employment.</li></ul> 

Physician Assistant 
<ul><li>
Current, valid Physician Assistant licensure from the Texas Board of Physician Assistants. Current certification as a Physician Assistant by the National Commission on Certification of Physician Assistants.</li></ul> 

Advanced Practice Registered Nurse (Nurse Practitioner) 
<ul><li>
Current RN licensure from the Texas Board of Nursing or a valid Compact RN license.</li><li>
Current licensure from the Texas Board of Nursing as an Advanced Practice Registered Nurse (APRN) with authorization to practice as a Family, Adult, Gerontology, Adult-Gerontology, Adult-Gerontology Acute Care, Acute Care, Pediatric, Pediatric Acute Care, Neonatal, Psychiatric Mental Health, or Women's Health Nurse Practitioner.</li></ul> 

Must have an active certification as a Nurse Practitioner by one of the following 
<ul><li>
Family Nurse Practitioner (FNP) by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners Certification Program (AANPCP)</li><li>
Adult Nurse Practitioner (ANP) by ANCC or AANPCP</li><li>
Gerontology Nurse Practitioner (GNP) by ANCC or AANPCP</li><li>
Adult-Gerontology-Primary Care Nurse Practitioner by ANCC or AANPCP</li><li>
Adult-Gerontology-Acute Care Nurse Practitioner by the ANCC or the American Association of Critical-Care Nurses Certification Corporation (AACNCC)</li><li>
Acute Care Nurse Practitioner (ACNP) by ANCC or AACNCC</li><li>
Pediatric Nurse Practitioner Primary Care (PNP-PC or PPCNP) by the Pediatric Nursing Certification Board (PNCB) or ANCC</li><li>
Pediatric Nurse Practitioner Acute Care (PNP-AC) by PNCB</li><li>
Neonatal Nurse Practitioner (NNP) by NCC</li><li>
Psychiatric Mental Health Nurse Practitioner (PMHNP) by ANCC</li><li>
Women's Health Nurse Practitioner (WHCNP) by the National Certification Corporation.</li></ul> 

Advanced Practice Registered Nurse (Certified Nurse Midwife) 
<ul><li>
Current RN licensure from the Texas Board of Nursing, or a valid Compact RN license.</li><li>
Current licensure as an Advanced Practice Registered Nurse (APRN) with authorization to practice as a Nurse Midwife by the Texas Board of Nursing.</li><li>
Must have active certification as a Certified Nurse Midwife (CNM) by the American Midwifery Certification Board (AMCB) or its predecessor.</li></ul> 

Advanced Practice Registered Nurse (Clinical Nurse Specialist) 
<ul><li>
Current RN licensure from the Texas Board of Nursing or a valid Compact RN license. Current licensure from the Texas Board of Nursing as an Advanced Practice Registered Nurse (APRN) with authorization to practice as a Clinical Nurse Specialist.</li></ul> 

Must have an active certification as described below by one of the following 
<ul><li>
Adult Clinical Nurse Specialist (CNS) by ANCC or AACNCC</li><li>
Psychiatric Mental Health Clinical Nurse Specialist (CNS) by ANCC or AACNCC</li></ul> 

Required Tests for Placement Skills or Special Abilities 
 
Provides care to the assigned patient population in accordance with the current Texas Nursing Practice Act or Texas Medical Board Rules, as applicable to licensure, established protocols, a multidisciplinary plan of care, and clinical area-specific standards. 
<ul><li>
Must demonstrate leadership ability through both superior clinical skills and as a practice development resource.</li><li>
Must have effective verbal and written communication skills.</li><li>
Must have effective leadership skills to include motivation, recruitment, retention, and change management.</li><li>
Must demonstrate knowledge of Parkland policies, structure, procedures, and mission.</li><li>
Must demonstrate patient-centered behaviors.</li></ul> 

Responsibilities 
<ul><li>
Performs clinical practitioner duties in designated specialty areas. Obtains histories, performs physical exams, makes assessments, and orders tests to adequately assess and determine diagnoses and plan of care.</li><li>
Records health history, findings, treatment, and recommendations accurately, clearly, and concisely. Manages time effectively to ensure optimal use of patient and provider resources.</li><li>
Consult appropriately with supervising physicians and refer patients as necessary to ensure optimal patient outcomes.</li><li>
Patients and/or families are included in determining the plan of care when appropriate.</li><li>
Educates patients and their families to ensure self-management, follow-up, and adherence to established treatment.</li><li>
Supports interdisciplinary collaboration to ensure continuous quality care and promote positive health outcomes, with a focus on delivering excellent customer service and ensuring patient satisfaction.</li><li>
Stay informed about the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, and actively participating in professional organizations.</li><li>
Participates in PHHS education activities.</li><li>
Maintains and implements knowledge of all applicable rules, regulations, policies, laws, and guidelines that impact the respective APP fields.</li><li>
Develops effective internal controls that promote adherence to applicable state/federal laws, and the program requirements of accreditation agencies and federal, state, and private health plans.</li><li>
Maintains current professional certifications and licensure as required by the organization and the APP's governing body.</li><li>
Seek advice and guidance as necessary to ensure proper understanding and timely completion of all assigned modules and yearly PHHS obligations as defined by the corporate compliance department.</li><li>
Identifies work processes and flows for the assigned department. Suggests appropriate changes to improve work effectiveness, productivity, and efficiency that support the overall goals of PHHS or the area.</li><li>
Consistently provides quality customer service to internal and external PHHS customers.</li><li>
Assists in developing, implementing, and monitoring annual goals and objectives for the department that support the mission and objectives of PHHS and the department.</li><li>
Attends regular staff meetings.</li></ul> 

Requisition ID: 966329</div>

Advanced Practice Provider- Psychiatry PRN

Peak Behavioral Health

<div>Intake Clinician | Peak Behavioral Health | Santa Teresa, New Mexico
About the Job:
PURPOSE STATEMENT: 
The Intake Clinician is a behavioral health professional responsible for facilitating admissions, clinical intake assessments and prior authorization process to assure continuity for the most appropriate level of care for patients. Performs assessments, screens for clinical and medical appropriateness and communicates this information to a physician who makes the appropriate level of care decision. Works closely with business office, nursing, and clinical staff as well as external parties to ensure the timely admission of patients.
Roles and Responsibilities:<div><div>
ESSENTIAL FUNCTIONS:<ul><li>
Facilitates intake, admission, and prior authorization process for incoming patients.</li><li>
Performs insurance benefit verifications, disseminating the information gathered to patient, their families, and appropriate internal staff.</li><li>
Provides accurate and ongoing assessment of patient&rsquo;s status in the admission and prior authorization process.</li><li>
Facilitates the response to requests for services, including the initial response, the assessment and referral process, the designation of appropriate level of care, initiation/intake into services, and appropriate follow up activity.</li><li>
Follows EMTALA regulations to complete insurance verification and precertification&rsquo;s, when appropriate.</li><li>
Responds to inquiries about the facility within facility policy timeframes.</li><li>
Schedules/completes pre-admission assessments and communicates recommendations to patient or their family.</li><li>
Collaborates with other facility medical and psychiatric personnel to ensure appropriate recommendations and admissions.</li><li>
Performs ongoing assessments of physical/function, emotional, social, spiritual and financial needs of patients and implements crisis intervention and referral.</li><li>
Provides education regarding healthcare and social resource systems to empower patient and their family to access resources independently.</li><li>
Maintains all the documentation involved with the admissions process.</li></ul></div></div>
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:<ul><li>
Master&rsquo;s Degree from an accredited college or university in social work, counseling, psychology, mental health or a related field required. In some states, may also be a registered nurse, in which case, an associate's or bachelor's degree in nursing is required.</li><li>
One or more years&rsquo; experience in mental/behavioral health working with individuals in a clinical or observational capacity preferred.</li><li>
Experience in the managed care pre-certification process, level of care assessments and utilization preferred.</li><li>
Experience in clinical interviewing, patient assessment, referral, treatment planning, communicating with external review organizations or comparable entities, and working effectively with people of diverse backgrounds.</li><li>
Outstanding interpersonal and interviewing and assessment skills. Skill in telephone etiquette and paging procedures.</li></ul>
LICENSES/DESIGNATIONS/CERTIFICATIONS:<ul><li>
Current licensure, as required for the area of clinical specialty, i.e., current RN license, CAC or other clinical counseling or therapy license, as designated by the state in which the facility operates.</li><li>
CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).</li><li>
First aid may be required based on state or facility requirements.</li></ul>
SUPERVISORY REQUIREMENTS:
This position is an Individual Contributor.
Why Peak Behavioral Health?Peak Behavioral Health offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Peak Behavioral Health is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.</div>

Intake Clinician

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Intake Clinician