COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Authorization Nurse

  • Job ID: 305707169
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Revenue Cycle
  • Department: Rev Cyc Care Mgmt
  • Location: Work From Home
  • Union Position: No
  • Salary Range: $31.08 to $52.46 / hour

Description

UPMC Corporate is hiring an Authorization Nurse to join our team!  This role works a Monday through Friday during daylight hours.  The position will be fully remote.

The Authorization Nurse provides support to appropriate UPMC departments and healthcare providers by obtaining referrals and/or authorizations for any acute admissions, hospital services and treatments.  Drawing on a knowledge base of acute care experience and knowledge of payer regulations, is responsible for assessing medical necessity and ensuring the presences of supporting documentation to obtain authorization.  Communicates pertinent clinical information to Physicians, Medical Directors or CFO.

Do you have prior RN experience?  If so, this could be the role for you!

Responsibilities:

 

  • Serve as a liaison between care managers and payors and facilitates payor/physician contact when indicated.
  • Communicates to the Medical Directors, Attending Physicians and/or CFO, if indicated, regarding evaluation of medical appropriateness.
  • Act as a resource to other departments as well as the care managers leveraging clinical expertise relative to the authorization process.
  • Collaborate with other departments to ensure all information/documentation is obtained to support authorization, level of care and/or medical appropriateness.
  • Ensure clinical review process is followed in order to meet payor deadlines.
  • Report to management on an ongoing basis trends/barriers that could necessitate process improvement from a concurrent standpoint.
  • Assist in determining system-wide care management needs through investigation of authorization process and identification of root cause.
  • Identify and assigns a root cause to each case to ensure denial reasons are tracked.
  • Monitor and evaluates for area of process improvement related to the payor specific authorization process.
  • Maintain current knowledge of regulatory guidelines related to authorizations.
  • Perform clinical review for cases referred for cases requiring authorization or adherence to payor medical policies.
  • Maintain collaborative relationships with utilization management and departments at payor organizations.
  • Provide ongoing education/feedback to care managers and other departments as related to the payor specific authorization process.

 

Qualifications

  • RN required; BSN or Bachelor's degree preferred.
  • Licensed in the State of Pennsylvania.
  • Five years of acute care clinical experience, two years payer or care management experience.
  • Understanding of clinical and care management process Knowledge of medical necessity criteria (InterQual).
  • Ability to apply InterQual criteria appropriately.
  • Prior utilization review experience. Knowledge of payer reimbursement structure.
  • Excellent customer service skills.
  • Negotiation skills for obtaining appropriate level of care.
  • Critical thinking/assessment skills.
  • Self motivation/autonomy.
  • Organization/time management and prioritization skills.
  • Proficient in Microsoft Word and Microsoft Excel.
  • Experience working with databases preferred.


Licensure, Certifications, and Clearances:

  • Registered Nurse (RN)

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

Security Alert

We are aware of scams targeting UPMC and other large companies that involve individuals posing as employees to illegitimately conduct interviews and extend false employment offers and payments to gain access to candidates' personal information. Please note that UPMC will not communicate with candidates through third-party email services like Gmail or Yahoo. While some interviews may take place via a video conferencing service, UPMC Talent Acquisition will not conduct interviews via Skype or Google Hangouts. UPMC will never ask for or disburse funds during the recruitment process. If you are hired into a role with a sign-on bonus or similar incentive, funds will be paid to you by UPMC after your start date.

If you suspect you have been a victim of a fraudulent UPMC job offer, please report the attempt using this form.