Do you want to work for a company that has been recognized by the Denver Post for nearly a decade as a Top Place to Work? Then Physician Health Partners may be the company for you! PHP offers a robust benefit package where the company pays for a majority of medical premiums, vision insurance, dental insurance, 2-week paid FMLA, 401(k) matching, in addition to some perks like happy hours, remote work options and profit sharing! We have two locations in Downtown Denver and Colorado Springs but serve members throughout the state Colorado. If you are interested in working for an innovative and collaborative workplace in the healthcare market than PHP may be the career home for you.

Position Summary: This position is specific to the Prior-authorization Services division of Care Management. This is a professional position that uses clinical judgment and critical thinking as part of a comprehensive program to assist PHP primary care physicians in their efforts to provide the highest quality care to their patients. The Prior Authorization Nurse for is responsible for clinical review of requests for health care services.

This is a Hybrid role working 40 hours a week Monday - Friday

Remote work is limited to candidates who live in (or are willing to relocate to) the following states: Colorado, Florida, Georgia, Indiana, or Texas

COMPETENCIES/Role-Specific Functions:

COMMUNICATION
Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

• Develops and maintains a good working relationship with team members, other departments, medical directors, and provider offices.
• Uses customer service and communication skills to interact with providers and provider offices.

PROBLEM SOLVING
Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.

• Participates in identifying issues related to the prior authorization process and seeks creative solutions to resolve issues.

PRODUCTIVITY
Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow.

• Responsible to participate in monitoring case loads and allocation of staff resources to effectively manage workloads through collaboration with other team members.
• Utilizes clinical judgment to evaluate requests according to accepted guidelines, taking into account the member’s plan benefits and clinical condition (age, co-morbidities, complications, progress of treatment, psychosocial situation, and home environment). Identifies potential case management issues and forwards to the appropriate person or department.
• Follows appropriate process to review healthcare service requests.

SELF DEVELOPMENT
Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.

• Develop a good working relationship with other team members.

CUSTOMER FOCUS
Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

• Participates as a part of the prior authorization team by actively interacting with other team members to distribute work fairly and resolve issues.
• Clearly and accurately documents relevant information.

JOB KNOWLEDGE
Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.

• Understands contractual and regulatory requirements applicable to the prior-authorization process.

Qualifications (Education/Experience/Knowledge/Skills):

• Graduate of accredited school of nursing, Current unrestricted Colorado license.
• Three to Five years clinical nursing experience. Previous utilization management, case management or discharge planning experience preferred.
• Strong clinical knowledge as well as NCQA and Medicare guidelines.
• Strong communication skills.
• Computer competency using MS word, excel and outlook.
• Ability to solve resource issues in a creative and positive manner to promote a positive and effective prior-authorization process.
• Must have ability to work as a team player with excellent coaching, team building and problem solving skills.
• Ability to make independent decisions when circumstances warrant.
• Required Licensure or Certification for this position must be maintained by the employee as defined by the company policies and procedures.
• Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.

COVID 19: Employees will be required to show proof of being fully vaccinated to COVID-19 within 30 days of hire or be subject to frequent antigen testing. Reasonable accommodations may be considered on a case by case basis.

Job Type: Full-time

Pay: $65,711.00 - $82,139.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• Remote work is limited to candidates who live in (or are willing to relocate to) the following states: Colorado, Florida, Georgia, Indiana, or Texas. Which State are you located in or willing to relocate to?
• What is your desired yearly salary?

License/Certification:

• RN License (Preferred)

Work Location: Remote

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