SSM Health RN-Prior Authorization Maternal Fetal Medicine in Saint Charles, Missouri
Monday-Friday 7:00am - 3:30pm
Obtain prior authorizations from various insurance companies by submitting clinical information via fax or speaking directly to a case management representative.
Collaborate with insurance companies and physician offices to obtain prior authorization approvals for patient treatment for complex illnesses.
Worked as a Prior Authorization specialist preparing documentation received from physician's offices for insurance companies.
Provide the necessary medical information to insurance companies to obtain authorizations for the requested study.
Provided superior customer service through phone/fax management skills, computer documentation of codes and clinical information for claims.
Knowledge and experience with Labor and Delivery and/or high risk OB is strongly encouraged for this role.
Collects and analyzes pertinent health data to develop and implement an individualized plan of care that includes interventions and alternatives to attain expected, measurable outcomes for women and newborns in the context of woman, newborn, and family-centered care.
Coordinates care delivery to promote woman-, newborn-, and family-centered care within their scope of practice. Employs health teaching strategies that promote, maintain, or restore health within the context of a safe environment for woman, newborn, family-centered care.
Evaluates the progress toward attainment of expected outcomes in the context of woman, newborn, and family-centered care.
Determines decisions and actions on behalf of women, fetuses, and newborns in an ethical manner and guided by a sound framework for ethical decision-making. Practices in a manner that is congruent with cultural diversity and inclusion principles when caring for women, newborns, and families.
Communicates and collaborates with women, families, health care providers, and the community in providing safe and holistic care.
Serves as a role model, change agent, consultant, and mentor to women, families, healthcare consumers, and other health care professionals. Acquires and maintains knowledge and competencies that reflect current evidence-based nursing practice for women, newborns, and families.
Generates or integrates evidence to identify, examine, validate, and evaluate interprofessional knowledge, theories, and varied approaches in providing care to women and newborns. Practices, evaluates, and, if indicated, implements new measures to improve the quality of nursing practice for women and newborns.
Evaluates their own nursing practice and participates in the evaluation of others in relation to current evidence-based consumer care information, professional practice standards and guidelines, statutes, rules and regulations. Considers resource factors related to safety, effectiveness, technological advances, and fiscal responsibility when planning and delivering care to women and newborns.
Practices in an environmentally safe and healthy manner when planning and delivering care to women, newborns, and families.
Applies the existing body of evidence-based practice and scientific knowledge in health care to women's services nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the departments Scope of Service.
Works in a constant state of alertness and safe manner.
Performs other duties as assigned.
- Graduate of accredited school of nursing
- No experience required
Constant use of speech to share information through oral communication.
Constant standing and walking.
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, reaching and keyboard use/data entry.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of smell to detect/recognize odors.
Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Occasional lifting/moving of patients.
Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements.
Rare crawling and running.
SSM Health is committed to equal employment opportunity based on race, color, religion, national origin, gender, sexual orientation, gender identity, pregnancy, age, physical or mental disability, veteran status, and all other statuses protected by law.