RN / Registered Nurse - PreCert & Appeals - Remote - Per Diem - Days

About the position The RN / Registered Nurse - PreCert & Appeals position at ProMedica Health System is a remote, per diem role focused on performing prior authorization and certification for scheduled services, particularly in oncology treatments. The role involves clinical review, documentation submission, and communication with payers and cancer center staff to ensure timely authorizations and appeals when necessary. This position requires a strong understanding of medical criteria and coding, as well as the ability to manage a high volume of work effectively. Responsibilities • Performs clinical review and document submission to obtain pre-certification/authorization requests for chemotherapy and non-chemotherapy plans, radiation therapy, and advance imaging and blood management plans. , • Completes consistent review of individual payer policies to identify changes affecting authorizations and maintains current knowledge on medical criteria relating to prior authorization requirements. , • Reviews and assists with denial management reports, identifying and reporting payer trends, denial patterns, and delays to management. , • Communicates with cancer center staff regarding authorization status and decisions as appropriate. , • Participates in process development and improvement related to authorizations, communication, and education. , • Demonstrates a general understanding of coding for hospital and imaging services, including review of hospital records. , • Thoroughly documents actions taken in appropriate information system(s). , • Additional responsibilities/duties will be assigned based on teamwork load and competency. Requirements • Nursing degree , • 2 years of clinical experience , • RN license , • Certification in prior oncology pre-certification/authorization , • Familiarity with ICD10 and CPT codes applicable to services rendered , • Demonstrated ability to communicate with medical and administrative staff and patients , • Strong organizational skills and ability to multi-task , • Effective interpersonal and telephone/electronic messaging etiquette skills , • Intermediate computer knowledge and proficiency in general office applications , • Ability to accurately and independently solve problems , • Ability to manage large volumes of work and quickly learn and retain information regarding issues. Nice-to-haves • Bachelor's degree , • Specific knowledge of medical payers , • Oncology experience , • EPIC electronic health record experience

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