Case Manager/Prior Authorization RN- Pain & Wound Clinics

RN Case Manager Pain and Wound Clinics

Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.

• When you join the LMHS team, you become a vital part of your local community Hospital.
• Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors.
• You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community.
• Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion.
• Join us in our mission – dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.

Position Summary

The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their procedure or therapy qualifies for insurance coverage. The nurse assesses, evaluates, and provides recommendations to help ensure patients receive the services they need. Responsible for working denial queues to facilitate resolution for denied claims.

Responsibilities

• Accurate review of coverage benefits and payer policy limitations to determine the appropriateness of requested services.
• Works closely with pain, wound staff, and schedulers for upcoming patient procedures, rescheduled procedures, and denials.
• Follows up with patients as necessary.
• Performs timely prospective and retrospective reviews for services requiring prior authorization as well as timely concurrent review for continuation of care services.