About this role
Position Title: Family Medicine Prior Authorization Nurse (LPN or RN) - Full Time (FT)
Department: Family Medicine
Reports to: Director of Nursing, Family Medicine
York General is seeking a detail-oriented and collaborative Prior Authorization Nurse (RN or LPN) to support our Family Medicine team. In this role, you will coordinate insurance prior authorizations for medications, procedures, diagnostic testing, durable medical equipment, and other healthcare services, helping patients receive timely access to the care they need. You will work closely with providers, clinical staff, pharmacies, insurance companies, and patients to navigate authorization requirements and resolve coverage issues.
What You'll Do:
• Review provider orders, treatment plans, and clinical documentation to determine authorization requirements.
• Submit and manage prior authorization requests for medications, procedures, testing, and other services.
• Communicate with insurance companies regarding coverage determinations, denials, appeals, and authorization requirements.
• Coordinate with providers, clinic staff, pharmacies, and patients to support treatment access and care continuity.
• Manage denial appeals, reconsiderations, and peer-to-peer review processes.
• Maintain accurate documentation within the electronic medical record (EMR).
• Stay current on payer requirements, regulatory standards, and authorization best practices.
• Monitor authorization outcomes and identify opportunities to improve workflows and patient access.
What You'll Bring:
• Graduate of an accredited nursing program.
• Current Nebraska RN or LPN license.
• Minimum of one year of nursing experience.
• Strong organizational, communication, critical thinking, and time management skills.
• Ability to interpret clinical documentation and payer requirements.
• Proficiency with electronic medical records and healthcare technology systems.