Adult Surviving Sepis Campaign Guidelines (Hour-1 Bundle)
Children's Surviving Sepsis Campaign Guidelines
Adult ICU Liberation Guidelines and Bundle (A-F)
Management of Adults with COVID-19
Forgot username or password?
New User? Sign Up Free
Roslyn, New York
San Antonio, Texas
Los Angeles, California
El Paso, Texas
New Orleans, Louisiana
Oklahoma City, Oklahoma
Cooperstown, New York
West Islip, New York
Pinehurst, North Carolina
Location: Phoenix, Arizona
Type: Full Time
Internal Number: R51421
The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. If you're ready to change lives, we want to hear from you.
"Work for a someone that believes in you" "If you have a strong clinical and analytical background, as well as a spirit for innovation, Banner Health is where you can make a dramatic difference in clinical customer service.
Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.
POSITION SUMMARY Under the direction of the Medical Management Director, Sr Manager and Medical Director, this position is responsible to process health plan medical prior authorization requests, provide case management, care coordination and perform utilization management duties within the appropriate time period as outlined in the BPA and UAHP Medical Management Program Descriptions, and in accordance with all federal and state regulations. CORE FUNCTIONS 1. Participates in duties to support prior authorization, concurrent review, and case management within Medical Management. Ensures quality of service and consistent documentation. 2. Performs transfer of accurate, pertinent patient information to support the prior authorization of services, the transition of the patient's needs during transitions of care, and perform follow-up discharge calls for advanced care coordination. Documents accurately and timely, all interventions and necessary patient related activities in the correct medical record. 3. Works cooperatively with both internal and external customers in assisting members and providers with issues related to prior authorization, utilization management, and/or case management. Meets internal and external customer service expectations regarding duties and professionalism. 4. Conducts call rotation for the health plan, as well as departmental call rotation for holidays. 5. Maintains a thorough understanding of accreditation standards and of CMS standards for determination of the medical necessity of services requested. 6. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Identifies issues that may delay patient services and refers to case management, when indicated to facilitate resolution of these issues, pre-service, concurrently and post-service. 7. Maintains a thorough understanding of each plan, including the Evidence of Coverage, authorization requirements, and all applicable federal, state and commercial criteria, such as CMS, AHCCCS, MCG, and Hayes. 8. Performs other related duties as assigned, which are consistent with the goals and qualifications of this position. 9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization. MINIMUM QUALIFICATIONS Current, unrestricted Arizona Licensed Practical Nurse (LPN) license permitting work in the State of Arizona. A minimum of three years of experience in an acute care setting. At least two years of experience in prior authorization, utilization management, or case management. Concurrent and retrospective data management skills are necessary. Working knowledge of medical terminology and coding (ICD-9/10, CPT-4) is required. Computer, data entry and word processing skills, as well as excellent written and verbal communication skills. Must have a working knowledge of care management, prior authorization, hospital and community resources, and utilization management. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format, Must be able to work flexible hours and may need to take rotating call after hours. Proficient on a computer (PC) with Microsoft Office Products. Ability to work with data bases/programs, and ability to work independently, with analytical, problem solving, decision making. PREFERRED QUALIFICATIONS
Experience specific to Med/Surg, managed care and knowledge of Federal and State programs as well as Commercial plans. Working knowledge of clinical criteria such as MCG (Milliman) or InterQual is preferred. Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
Don't miss an opportunity! Access the latest job postings from your mobile device. Career Central is available within the SCCM App.