P3 Health Partners Henderson , NV 89044
Posted 2 weeks ago
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.
We are looking for a Prior Authorization Nurse. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, Nevada, then you should consider joining our team.
Overall Purpose: The UM Nurse is responsible for compliance with the Medical Management Program Description of P3 Health Partners regarding Utilization Review, inclusive of prior authorization, concurrent and retrospective review, discharge planning and transitions of care to the appropriate level. The UM Nurse adheres to the standard operating procedures that support achieving the Quadruple Aim: improved outcomes, improved patient experience, improved clinician experience and decreased cost of care. The UM Nurse will integrate the functions of utilization review, discharge planning and resource management into a singular effort to ensure, based on patient assessment and best practice, that care is provided in the appropriate setting utilizing medically indicated, contracted resources.
Essential Functions:
Promote the mission, vision and values of P3 Health Partners
Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies and approve services as per policy or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
Obtain additional clinical information from requesting provider or other sources when necessary for determinations
Complete medical necessity and level of care reviews for requested services using clinical judgment. Refer to Medical Directors for review depending on case findings
Collaborate with various staff within provider networks and Medical Management teams electronically or telephonically to coordinate care
Educate providers on utilization and Medical Management processes
Provide clinical knowledge and act as a clinical resource to non-clinical team
Enter and maintain pertinent clinical information in various Medical Management systems
Address gaps in care
Required Qualifications:
Current, unrestricted Nevada RN license or compact license
2+ years of experience in managed care OR 5+ years of nursing experience
Proficient in PC Software computer skills
Preferred Qualifications:
Prior Authorization experience
Telephonic and/or telecommute experience
Utilization Review / Management experience
ICD-10, CPT coding knowledge / experience
InterQual experience
Excellent communication skills both verbal and written skills
Solid problem solving and analytical skills
Ability to interact productively with individuals and with multidisciplinary teams with minimal guidance
Possess planning, organizing, conflict resolution, negotiating, and essential interpersonal skills
P3 Health Partners