Licensed Practical Nurse (LPN) II - Preservice - USA Health

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community.

USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.

Essential Job Functions

• Verify insurance for scheduled procedures prior to submission for authorization.
• Responsible for reviewing, analyzing and submitting required clinical information to insurance payers for pre-treatment authorizations.
• Makes recommendations to meet payer, regulatory and quality standards.
• Stays up-to-date on insurance payer medical policies, payer specific clinical certification/referral requirements and acts as expert resources for clinical staff in these areas.
• Obtains timely insurance certification by clearly and concisely communicating the pertinent clinical data to the insurance payer regarding the physician’s documented medical necessity.
• Collaborates with all members of the patient care team to resolve insurance certification/referral issues in a timely manner.
• Documents certification process and authorization number information correctly and timely in the computer system to facilitate accurate concurrent review.
• Other duties as assigned.

Other Duties and Responsibilities

Coordinates with other departments in the health system to provide quality patient services.  Ensures smooth and efficient pre-registration functions by expediting problems.  Ensures accurate information is being collected and entered correctly to the HSIS system.  Confirm that all insurance benefits meets standards of admission as dictated by policy.  Demonstrates sound judgement and ability to make effective decisions.  Adheres to departmental and hospital policies, including the ability to process and maintain confidential patient and business information.  Communicates and uses appropriate customer relation skills with administrative and departmental staff, technical staff, physicians, nurses, patients, families, other hospital staff and vendors in person, via email and by telephone.

Graduation from an accredited school of practical nursing meeting the minimum standards set by the State of Alabama and current Alabama Licensed Practical Nurse (LPN) license or current Multi-State LPN License in accordance with the Nurse Licensure Compact (NLC) for Alabama and two years of LPN experience. Note: USA Health abides by the NLC requirements and guidelines for the state of Alabama.