Henry Ford Health System
RN Referral Management Coordinator (Virtual) - Prior Authorizations - 40 Hours -
Henry Ford Health System, Troy, Ohio, United States, 45373
Employer Industry: Healthcare Services
Why consider this job opportunity?
Full-time position with a day shift schedule, Monday through Friday, from 8:00 AM to 4:30 PM
Opportunity to work remotely, offering flexibility in your work environment
Benefit-eligible position with a focus on a supportive team of healthcare professionals
Chance to transition from bedside care to a role that emphasizes clinical management and quality assurance
Engage in meaningful work that directly impacts patient care and quality management
What to Expect (Job Responsibilities)
Process referral requests by verifying network assignments, correct providers, and applying clinical criteria
Coordinate peer-to-peer conversations with the Medical Director and providers during the referral process
Manage denial processing according to policy and distribute provider denial letters as neededReport potential quality of care issues to the Quality Management Department for investigation
Track physician non-compliance with Utilization Management Policies & Procedures
What is Required (Qualifications)
Nursing Diploma is required
Minimum of two (2) years of recent clinical management experience in an inpatient or ambulatory setting or in Utilization or Quality Management
Registered Nurse (RN) with current Michigan licensure
How to Stand Out (Preferred Qualifications)
Bachelor's Degree in Health Care or a related field
Experience in a prior authorization role within a healthcare setting
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
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Full-time position with a day shift schedule, Monday through Friday, from 8:00 AM to 4:30 PM
Opportunity to work remotely, offering flexibility in your work environment
Benefit-eligible position with a focus on a supportive team of healthcare professionals
Chance to transition from bedside care to a role that emphasizes clinical management and quality assurance
Engage in meaningful work that directly impacts patient care and quality management
What to Expect (Job Responsibilities)
Process referral requests by verifying network assignments, correct providers, and applying clinical criteria
Coordinate peer-to-peer conversations with the Medical Director and providers during the referral process
Manage denial processing according to policy and distribute provider denial letters as neededReport potential quality of care issues to the Quality Management Department for investigation
Track physician non-compliance with Utilization Management Policies & Procedures
What is Required (Qualifications)
Nursing Diploma is required
Minimum of two (2) years of recent clinical management experience in an inpatient or ambulatory setting or in Utilization or Quality Management
Registered Nurse (RN) with current Michigan licensure
How to Stand Out (Preferred Qualifications)
Bachelor's Degree in Health Care or a related field
Experience in a prior authorization role within a healthcare setting
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
#J-18808-Ljbffr