WomanCare Centers
Prior Authorization Nurse
Norfolk, Virginia•Full-time
$25 - $31 hourly
$25 - $31 hourly
About the Job
WomanCare Centers
Prior Authorization Nurse
We are a busy, patient-centered OB/GYN outpatient practice dedicated to providing compassionate, comprehensive care to women at every stage of life. Our team values communication, collaboration, and continuity of care—both in and out of the office.
We’re seeking an experienced Medication Prior Authorization Nurse to join our dynamic team in an in-person, non-remote position. The primary focus of this role is the timely and accurate management of medication prior authorizations, working closely with providers, pharmacies, insurance companies, and patients to facilitate access to prescribed medications.
Responsibilities:
- Manage medication prior authorizations as the primary responsibility of the position, including initiating, completing, submitting, and tracking prior authorization requests.
- Review medication orders and insurance requirements to determine appropriate prior authorization processes and required documentation.
- Gather and submit supporting clinical documentation, including diagnoses, treatment history, laboratory results, and other information required for authorization.
- Monitor pending prior authorizations and proactively follow up to ensure timely resolution and minimize delays in patient treatment.
- Assist with appeals, reconsiderations, peer-to-peer requests, and alternative medication options when prior authorization requests are denied, as directed by the provider.
- Maintain accurate and timely documentation of all prior authorization activities in the electronic health record (EHR).
- Process medication refill requests as appropriate, ensuring clinical appropriateness and adherence to established protocols.
- Stay current with payer requirements, medication authorization processes, and changes that may affect patient access to medications.
- Other duties as assigned.
Qualifications Desired:
- Minimum of 2 years of nursing experience in Prior Authorizations.
- Strong clinical assessment, critical thinking, and problem-solving skills.
- Excellent communication, organization, documentation, and time-management skills.
- Strong attention to detail and ability to manage multiple prior authorizations and follow-up tasks simultaneously.
- Ability to work independently while collaborating effectively with providers, pharmacies, insurance companies, and members of the care team.
- Compassionate, patient-centered approach to care.
- Ability to work in person; this position is not eligible for remote work.
- Familiarity with medication formularies.
- Knowledge of common OB/GYN conditions, including prenatal care, contraception, menstrual issues, menopause, infections, and pregnancy complications.
Why Join Our Team?
- Paid time off that increases with tenure.
- Major federally recognized holidays off with pay.
- Competitive benefits package with optional supplemental benefits.
- Leadership dedicated to cultivating and maintaining a positive environment that encourages professional growth.
- Opportunities to take on healthy challenges and develop your clinical and administrative skills.
- A collaborative team environment with coworkers who encourage and support one another in achieving success.