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Role Description

This position exists to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to the request for prior authorization. Specific duties are determined by the work setting or patient population served; however, in all positions, serving patients with challenging and complex conditions requires a concentration of specialized staff able to work in highly coordinated teams. We organize care around each patient’s condition which requires staff at multiple levels and across many departments to exhibit exceptional teamwork qualities including:

• Communicating efficiently and effectively
• Adopting the behaviors required for high functioning integrated teams

Qualifications

• Minimum licensure as a Licensed Practical Nurse (LPN) from the MN Board of Nursing is required. Candidates/incumbents with a valid MN Registered Nursing (RN) License are qualified for this position as well.
• Documentation of completion of a practical nursing program (LPN program)
• If candidate holds a RN license instead of LPN license, documentation of RN education program is required.
• Knowledge of pharmacy, pharmaceuticals or healthcare business.
• Minimum one year of nursing experience in a healthcare environment

Requirements

• Knowledge of Payer requirements and expectations regarding prior authorization
• Familiarity with CPT/HCPCS and ICD-10
• Ability to proficiently analyze and interpret clinical criteria
• Works effectively across organization and fosters teamwork
• Demonstrates the ability to utilize resources while building strong credible working relationships with clients, patients and internal partners
• Demonstrated excellent customer service and communication skills – verbal, written, and listening.
• Demonstrated knowledge of medical terminology
• Proficient technology skills, including working with a computer (PC) using Microsoft Office Products, databases and other programs.
• Must demonstrate ability to work independently with analytical, problem-solving and decision-making.

Benefits

• The hourly wage for this opportunity is $23.98 to $35.97, with a median wage of $29.97/hour.
• Pay is dependent on several factors including relevant work experience, education, certification & licensure, and internal equity.
• Gillette supports career progression and offers a competitive benefits package that includes:
• Retirement savings match
• Tuition and certification reimbursement
• Paid time off
• Health and wellness benefits for .5 FTE and above