Health Alliance Plan
RN Referral Management Coordinator (Virtual) - Prior Authorizations - 40 Hours -
Health Alliance Plan, Troy, Michigan, United States, 48083
RN Referral Management Coordinator (Virtual) – Prior Authorizations
Job Summary
This role is a full‑time, 40‑hour/day shift, remote position for Health Alliance Plan.
Key Responsibilities
Process referral requests by verifying network assignment, correct provider, applying criteria to determine clinical appropriateness, and assessing level of care requirements.
Coordinate peer‑to‑peer conversations with the Medical Director and the provider at the time of the request.
Follow denial processing when the Medical Director denies the request, process a provider denial letter, and distribute it to Utilization Management Services staff for processing.
Report potential quality‑of‑care issues to Quality Management Department; track physician non‑compliance with UM policies and report via physician profiling procedures.
Qualifications
Registered Nurse (RN) with current Michigan licensure.
Nursing diploma required; Bachelor’s degree in health care or related field preferred.
Minimum two (2) years of recent clinical management experience in an inpatient or ambulatory setting, or at least two (2) years in Utilization or Quality Management.
Additional Information
Organization: HAP (Health Alliance Plan)
Department: Prior Authorizations
Shift: Day, Monday through Friday 8:00 AM – 4:30 PM
Employment type: Full‑time
Seniority level: Associate
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This role is a full‑time, 40‑hour/day shift, remote position for Health Alliance Plan.
Key Responsibilities
Process referral requests by verifying network assignment, correct provider, applying criteria to determine clinical appropriateness, and assessing level of care requirements.
Coordinate peer‑to‑peer conversations with the Medical Director and the provider at the time of the request.
Follow denial processing when the Medical Director denies the request, process a provider denial letter, and distribute it to Utilization Management Services staff for processing.
Report potential quality‑of‑care issues to Quality Management Department; track physician non‑compliance with UM policies and report via physician profiling procedures.
Qualifications
Registered Nurse (RN) with current Michigan licensure.
Nursing diploma required; Bachelor’s degree in health care or related field preferred.
Minimum two (2) years of recent clinical management experience in an inpatient or ambulatory setting, or at least two (2) years in Utilization or Quality Management.
Additional Information
Organization: HAP (Health Alliance Plan)
Department: Prior Authorizations
Shift: Day, Monday through Friday 8:00 AM – 4:30 PM
Employment type: Full‑time
Seniority level: Associate
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