Job Description

  • Requisition ID
    01 - Days
    Innovation Care Partners
    Innovation Care Partners
    Position Type
    Regular Full-Time
    Physical Work Location and New Employee Orientation Location : Address
  • Overview

    HonorHealth is a non-profit, local healthcare organization known for community service and outstanding medical quality. HonorHealth encompasses five acute care hospitals with approximately 11,500 employees and 4,500 volunteers, over 70 primary and specialty care practices, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.

    HonorHealth is a leader in medical innovation, talent and technology with a genuine commitment to your growth. The health system's vibrant careers take place in an environment filled with opportunity and respect because we see the HONOR in you.


    High School Diploma or GED Required

    1 year health plan based prior authorization experience. Required


    Job Summary
    The Prior Authorization (PA) Specialist is responsible for the review of requests for authorization of services and coordinates the timely completion of the authorization process for Utilization Management Department. The PA Specialist will review referral and admission requests, verify eligibility, benefit information and determine whether sufficient clinical information has been submitted for review utilizing health plan, CMS, MCG or other nationally recognized criteria/guidelines, approves referrals and admission requests if criteria and guidelines are met.
    • Receives referral and admission requests from practices and acute/post-acute facilities. Verifies patient's demographic and insurance information within billing system. Coordinates PA process in MCG software and ensures appropriate documentation for criteria is met. Approves request or sends request for the Medical Director/designee review if criteria and guidelines are not met.
    • Requests additional information from medical office staff members and referring physicians as necessary
    • Identifies potential risk /quality management cases using established criteria and refers to Director. Coordinates PA issues with organization’s Medical Director/Designee. Follows organizations PA policies and procedures. Maintains professional conduct and good working relationships with co-workers, supervisors and other provider practices.
    • Maintains accurate logs of PA authorizations within software - date stamp all received documents sent to organization for processing. Obtains prior authorizations and referrals from practices in accordance with organization’s requirements using website and fax systems. Reviews medical records within IE and/or EPIC for appropriate submission to obtain authorizations.

    It is the policy of HonorHealth to provide equal opportunity in employment. Selection and employment of applicants will be made on the basis of their qualifications without regard to race, color, religion, creed, national origin, age, disability, sexual orientation, marital status, veteran status or any other legally protected status.

    Please review the Equal Employment Opportunity poster.

    Please review the Equal Employment Opportunity Poster.HonorHealth wants all interested and qualified candidates to apply for employment opportunities. If you are an applicant with a disability who is unable to use our online tools to search and apply for jobs, please contact us at . Please indicate the specifics of the assistance needed. This option is reserved only for individuals with disabilities that are unable to use the online tools and is not intended for other purposes.

    Application Instructions

    Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

    Apply Online