Precert RN/LPN

Precertification Registered Nurse (RN) or Licensed Practical Nurse (LPN)

Location: Atlanta, GA 30342
Pay: $30-40/hr (Depending on experience/education) 
Hours: M-F, 8a-5p.
Job Type: Contract through end of July 2025. 

The Precertification RN ensures that patients’ drug treatments are authorized or clinically cleared by insurance providers. Their primary responsibility is securing authorization or clinical clearance and communicating it to the appropriate representatives for patient records.

• Review incoming drug precertification requests in the DrugAuths Inbox to determine compliance with insurance, FDA, and NCCN guidelines.
• Clinically assess chemotherapy and drug requests, ensuring they meet criteria beyond diagnosis codes, especially when IVU reps cannot authorize based on diagnosis alone.
• Verify that Site Nurses complete prior authorization forms accurately, ensuring correct clinical details before submission.
• Initiate prior authorization requests for required drugs via online tools or faxing necessary forms with supporting patient medical records.
• Process predetermination/prior authorization requests for high-cost drugs under BCBS out-of-state and other commercial plans to prevent post-claim denials.
• Provide IVU reps with rationale for non-clearance, assisting nurses in communicating this information to physicians.
• Initiate authorization requests for radiology procedures and genetic tests as needed.
• Compile and share peer-to-peer review details for scans, drugs, and procedures, including relevant policies for provider reference.
• Track and secure reauthorization for drugs requiring prior approval, ensuring documentation accuracy and compiling medical records when necessary.
• Attend meetings, in-services, and training as scheduled.
• Follow work processes and adhere to Atlanta Cancer Care’s policies and procedures.
• Perform additional duties, including cross-training and special projects, as assigned.
• Adjust responsibilities as needed due to COVID-19-related changes.
• Maintain adherence to service excellence standards.

• Education & Experience: BSN in Nursing with a valid GA State Medical License and at least three years of related experience in Oncology, a specialist’s office, or authorization processing.
• Preferred Skills:
  • Strong knowledge of medical terminology.
  • Excellent oral and written communication skills.
  • Effective interpersonal skills and a team-oriented mindset.
  • Ability to multitask and collaborate in a team-based environment.

• Computer Skills: Proficiency in Microsoft Office, printing, faxing, and scanning.
• Language & Math: Fluency in English (reading, writing, and speaking) and basic math competency.

This role is predominantly stationary, requiring frequent sitting or standing, repetitive wrist motions, grasping, speaking, listening, and visual acuity adjustments. Occasional lifting (up to 25 lbs.), walking, kneeling, bending, and reaching may be required.

Responsibilities, physical requirements, and work conditions may vary based on staffing and business needs. Essential functions are determined by role requirements rather than specific individual capabilities.

• Professionalism: Maintain respect, courtesy, and appropriate communication with patients, visitors, and colleagues while adhering to dress code and cleanliness standards.
• Communication: Provide clear information regarding patient financial experiences and use professional, service-oriented language.
• Responsiveness: Anticipate needs, provide updates on wait times, and address concerns proactively.
• Ownership & Accountability: Uphold confidentiality, participate in process improvements, and collaborate to ensure high-quality patient care.
• Commitment to Teamwork: Support coworkers, maintain a cooperative environment, and contribute to shared responsibilities.

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