Authorization Management RN, Days

The Authorization Management RN acts as a patient advocate. He/she works closely with the hospital-based RN Care Managers, Utilization Review LPNs and other multi-disciplinary staff to research and provide accurate and timely clinical review on the more complex, critical patient cases (for example: spine, cardiology, neurology) to ensure that more complex inpatient admission approval is secured from governmental and non-governmental payors. Payor requirements are met with the goal of preventing technical and clinical denials. The Authorization Management RN works towards the resolution of denials by utilizing nationally recognized criteria for appeal submission. The Authorization Management RN interacts with outside agencies, third party payors and managed care companies in accordance with contractual agreements

Required:

• Five years clinical experience in medical surgical or critical care nursing.
• Diploma Nursing
• Registered Nurse (KY)