Oncology Case Manager

Oncology Case Management Prior Authorizations  

Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community.  With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.

When you join the LMHS team, you become a vital part of your local community Hospital.  Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors.  You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community.  Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion.  Join us in our mission – dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.

Prior authorization nurse is responsible for gathering and submitting the necessary paperwork and information to the insurance company. Must have a clear understanding the requirements of the insurance company and obtaining the prior authorization number from the insurance company. This position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, transcribes and triages patient calls to physicians.

Responsibilities

• Receive and process Prior authorizations.


• Consults with multidisciplinary team as appropriate to develop, implement and evaluate care for patients and families.


• Documents patient care activities in patient medical records


• Complete documentation accurately and timely.

• Coordinate patient care with appropriate disciplines.


• Physician consultation for changes in patients' condition.

Requirements

• Registered nurse with two years of experience in delivering nursing care


• Analytical abilities and sound nursing knowledge.


• Effective communication skills.


• Knowledge of policies and procedures.


• CPR certification.


• Reliable transportation, current driver's license and automobile insurance.


• Oncology Nursing experience preferred.


• Graduate of accredited School of Nursing program maintains current licensure in State of Ohio.


• Functions within the scope of practice of nursing for registered nurse as defined by the Nurse Practice Act.


• Completes orientation as specified to acquire the necessary familiarity with LMHS policies, nursing procedures and techniques within assigned patient care areas.


• Efficiently participates in case of emergency (code blue, fire, weather, disaster).


• Demonstrates basic analytical ability to perform assigned tasks and gather and interpret data in situations that are not difficult or complex.


• Demonstrates ability to provide care for young adult, adult and geriatric patients under supervision of a licensed physician, NP and/or RN.


• Demonstrates ability to proficiently operate various office machines including a personal computer, office computer system (EPIC), fax, telephone, and photocopier.


• Demonstrates ability to type proficiently.


• LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations.  Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.