RN Medical Management Services
Banner Health · Phoenix, AZ · 1 mo ago
RemoteRemoteHealthcare$35.43–$59.05/hrFull-time
We need to output HTML fragment with sections: About the role? Actually we need to use headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections when posting has real specific content.
We need to extract content.
Job description includes:
- Department Name: Prior Authorization Work Shift: Day Job Category: Clinical Care (metadata, can be short p)
- Intro paragraph about Banner Health.
- Recognitions.
- Role description: RN Medical Management Services, technologically savvy, research sites, review plans, receive case reviews via fax, non-clinical team data entry, variety of cases based on Prior Authorization Grid, phone providers/vendors/members, ideal candidate experience in prior authorization, remote opportunity, hours Monday-Friday 8AM-5PM including Saturday rotations, must reside in AZ.
- Pay and benefits: Banner Health offers variety of benefits, health and financial security options.
- Banner Plans & Networks description (maybe about the role? Could be about the organization.)
- Position Summary: support and execution of programs, etc.
- Core Functions: list of duties.
- Minimum Qualifications: RN licensure, bachelor's degree, five years clinical experience, etc.
- Preferred Qualifications: certifications.
- Estimated Pay Range: $35.43 - $59.05 / hour
- Note about pay equity.
We need to remove boilerplate: EEO statement, privacy policy, etc.
We need to format:
- Use for section headings.
- Use
for section headings.
- Use - for any list of duties/requirements/benefits.
- Use
for prose.
- Do NOT repeat job title as heading.
- Do NOT put Job ID/requisition numbers as headings.
- Include section only when posting has real specific content.
We need to decide sections: About the role (intro), Responsibilities (core functions), Requirements (minimum qualifications), Qualifications (preferred qualifications), Skills (maybe from qualifications?), Benefits, Pay, Schedule.
We have schedule info: hours Monday-Friday 8AM-5PM including Saturday rotations, remote, must reside in AZ.
We have benefits: variety of benefits, health and financial security options.
We have pay: estimated pay range.
We have responsibilities: core functions list.
We have requirements: minimum qualifications.
We have qualifications: preferred qualifications.
We have skills: maybe from qualifications like critical thinking, problem-solving, communication, time management, interdisciplinary team, flexible hours, rotating call.
We could put skills section.
But we must avoid thin sections; prefer few substantive sections. Could combine Requirements and Qualifications into one "Qualifications" section with subparts? But instructions: use headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can include multiple if content exists.
We need to ensure we don't create sections with filler like "commensurate with experience". We have actual content.
Let's craft:
About the role
Intro paragraph about Banner Health, recognitions, role description, remote opportunity, hours, AZ residency.
Responsibilities
- ... list from Core Functions ...
Requirements
- ... Minimum Qualifications ...
Qualifications
- ... Preferred Qualifications ...
Skills
- ... critical thinking, problem-solving, effective communication, time management, ability to work in interdisciplinary team, flexible hours, rotating call after hours ...
Benefits
Banner Health offers a variety of benefits to help you and your family, including health and financial security options.
Pay
Estimated pay range: $35.43 - $59.05 per hour.
Schedule
Remote opportunity with hours Monday‑Friday 8 AM‑5 PM, including Saturday rotations; must reside in Arizona.
We need to ensure we preserve all substantive information. Let's extract details.
About the role content: Should include:
- Department Name: Prior Authorization Work Shift: Day Job Category: Clinical Care (maybe as metadata short p)
- The future is full of possibilities... (intro)
- Recognitions: Becker’s Healthcare top 150 places to work, Newsweek’s America’s Greatest Workplaces 2023 for Diversity.
- In this role of RN Medical Management Services, you are required to be technologically savvy when it comes to research for the plans you will help manage. Sites to aid in that research include CMS, Noridian, Optum360 Encoder Pro, (a provider lookup tool for contracted and noncontracted status,) and more.
- You will review plans and receive case reviews via fax and a non-clinical team data enters into the system for determinations.
- The variety of cases received is based on the Prior Authorization Grid for services that must be reviewed for determination.
- You are required to phone providers, vendors, and members for certain aspects within Banner's processes.
- An ideal candidate would possess experience in prior authorization.
- This is a remote opportunity, with hours of Monday-Friday 8AM-5PM, including Saturday rotations.
- Must reside in AZ.
- Your pay and benefits are important components... Banner Health offers a variety of benefits...
- Banner Plans & Networks (BPN) description (maybe about the organization, could be included in About the role or separate? Could be part of About the role as context.)
- Position Summary: This position provides support and execution of programs and tactics used to influence provider and health plan consumer/beneficiaries’ behaviors in order to achieve right care in the right place at the right time and the appropriate cost. Plans and provides support for health plan consumers/beneficiaries to align with the objectives of triple aim. This position is responsible to process health plan medical pre-service requests, provide case management, care coordination and perform utilization management duties within the appropriate time period as outlined in the Medical Management Program Descriptions, and in accordance with all federal and state regulations.
We could incorporate Position Summary into About the role or Responsibilities. But we already have Responsibilities from Core Functions. Position Summary is more overview; could be part of About the role.
We need to preserve all substantive info, not invent or summarize away detail. So we need to include the Position Summary text.
We could add a separate section "Position Summary" but not in allowed headings list. The allowed headings are specific; we should stick to those. So we can incorporate Position Summary into About the role or Responsibilities. Probably About the role.
Thus About the role will be a paragraph containing all that descriptive text (including Position Summary). Ensure we don't lose any detail.
Let's craft About the role paragraph:
"Banner Health is recognized as one of Becker’s Healthcare’s 150 top places to work in health care and appeared on Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity. In this role of RN Medical Management Services, you are required to be technologically savvy when researching plans using resources such as CMS, Noridian, Optum360 Encoder Pro (a provider lookup tool for contracted and noncontracted status) and more. You will review plans and receive case reviews via fax, with a non‑clinical team entering data into the system for determinations. Case variety is driven by the Prior Authorization Grid for services requiring review. You will phone providers, vendors, and members as needed within Banner’s processes. An ideal candidate possesses prior‑authorization experience. This is a remote position with Monday‑Friday 8 AM‑5 PM hours, including Saturday rotations, and requires residency in Arizona. The position supports Banner Plans & Networks (BPN), an accountable care organization that joins Banner Health with an extensive network of primary care and specialty physicians to deliver comprehensive healthcare solutions for Maricopa County and parts of Pinal County, collaborating to keep members healthy while reducing costs. The role provides support and execution of programs and tactics to influence provider and health‑plan consumer/beneficiary behaviors to achieve right care in the right place at the right time and appropriate cost, aligning with the triple aim. Responsibilities include processing health‑plan medical pre‑service requests, providing case management and care coordination, and performing utilization management duties per the Medical Management Program Descriptions and federal/state regulations."
That seems to capture a lot.
Now Responsibilities: Use Core Functions list.
Let's extract Core Functions bullet points:
- Manages health Plan consumer/beneficiaries’ across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes.
- Provides pre-service determinations, concurrent review, and case management functions within Medical Management.
- Ensures quality of service and consistent documentation.
- Works collaboratively with both internal and external customers in assisting health Plan consumer/beneficiaries’ and providers with issues related to prior authorization, utilization management, and/or case management.
- Meets internal and external customer service expectations regarding duties and professionalism.
- Performs transfer of accurate, pertinent patient information to support the pre-service determination(s), the transition of patient care needs through the continuum of care, and performs follow-up calls for advanced care coordination.
- Documents accurately and timely, all interventions and necessary patient related activities in the correct medical record.
- Evaluates the medical necessity and appropriateness of care, optimizing health Plan consumer/beneficiaries’ outcomes.
- Identifies issues that may delay patient services and refers to case management, when indicated to facilitate resolution of these issues, pre-service, concurrently and post-service.
- Provides ongoing education to internal and external stakeholders that play a critical role in the continuum of care model. Training topics consist of population health management, evidence based practices, and all other topics that impact medical management functions.
- Identifies and refers requests for services to the appropriate Medical Director and/or other physician clinical peer when guidelines are not clearly met.
- Conducts call rotation for the health plan, as well as departmental call rotation for holiday.
- Maintains a thorough understanding of each plan, including the Evidence of Coverage, Summary Plan Description authorization requirements, and all applicable federal, state and commercial criteria, such as CMS, MCG, and Hayes.
- Has freedom to determine how to best accomplish functions within established procedures.
- Confers with supervisor on any unusual situations.
- Positions are entity based with no budgetary responsibility.
- Internal customers: All levels of nursing management and staff, medical staff, and all other members of the interdisciplinary health care team.
- External Customers: Physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies.
We need to put these as - items.
Now Requirements: Minimum Qualifications bullet points:
- Requires Registered Nurse (R.N.) licensure in the state of practice. All license or certification must identify the issuing state or entity, type of licensure and expiration date or evidence that the certification is the type that does not expire.
- A bachelor’s degree or equivalent experience.
- Requires proficiency level typically achieved with five years of clinical experience.
- Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management.
- Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills.
- Must demonstrate ability to work effectively in an interdisciplinary team format.
- Must be able to work flexible hours and take rotating call after hours.
We'll list each as
- .
Now Qualifications: Preferred Qualifications bullet points:
- Certification(s) related to field, such as Certified Case Manager (CCM), MCG Certification(s), RN-BC Registered Nurse Case Manager, Certification in Managed Care Nursing (CMCN).
- Additional Related Education And/or Experience Preferred.
We'll list.
Now Skills: Could extract from requirements: critical thinking, problem-solving, effective communication, time management, ability to work in interdisciplinary team, flexible hours, rotating call after hours. Also maybe "technologically savvy" etc. But we can keep as derived.
We'll list those.
Now Benefits: "Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do
for prose. - Do NOT repeat job title as heading. - Do NOT put Job ID/requisition numbers as headings. - Include section only when posting has real specific content. We need to decide sections: About the role (intro), Responsibilities (core functions), Requirements (minimum qualifications), Qualifications (preferred qualifications), Skills (maybe from qualifications?), Benefits, Pay, Schedule. We have schedule info: hours Monday-Friday 8AM-5PM including Saturday rotations, remote, must reside in AZ. We have benefits: variety of benefits, health and financial security options. We have pay: estimated pay range. We have responsibilities: core functions list. We have requirements: minimum qualifications. We have qualifications: preferred qualifications. We have skills: maybe from qualifications like critical thinking, problem-solving, communication, time management, interdisciplinary team, flexible hours, rotating call. We could put skills section. But we must avoid thin sections; prefer few substantive sections. Could combine Requirements and Qualifications into one "Qualifications" section with subparts? But instructions: use headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can include multiple if content exists. We need to ensure we don't create sections with filler like "commensurate with experience". We have actual content. Let's craft:
About the role
Intro paragraph about Banner Health, recognitions, role description, remote opportunity, hours, AZ residency.
Responsibilities
- ... list from Core Functions ...
Requirements
- ... Minimum Qualifications ...
Qualifications
- ... Preferred Qualifications ...
Skills
- ... critical thinking, problem-solving, effective communication, time management, ability to work in interdisciplinary team, flexible hours, rotating call after hours ...
Benefits
Banner Health offers a variety of benefits to help you and your family, including health and financial security options.
Pay
Estimated pay range: $35.43 - $59.05 per hour.
Schedule
Remote opportunity with hours Monday‑Friday 8 AM‑5 PM, including Saturday rotations; must reside in Arizona.
We need to ensure we preserve all substantive information. Let's extract details. About the role content: Should include: - Department Name: Prior Authorization Work Shift: Day Job Category: Clinical Care (maybe as metadata short p) - The future is full of possibilities... (intro) - Recognitions: Becker’s Healthcare top 150 places to work, Newsweek’s America’s Greatest Workplaces 2023 for Diversity. - In this role of RN Medical Management Services, you are required to be technologically savvy when it comes to research for the plans you will help manage. Sites to aid in that research include CMS, Noridian, Optum360 Encoder Pro, (a provider lookup tool for contracted and noncontracted status,) and more. - You will review plans and receive case reviews via fax and a non-clinical team data enters into the system for determinations. - The variety of cases received is based on the Prior Authorization Grid for services that must be reviewed for determination. - You are required to phone providers, vendors, and members for certain aspects within Banner's processes. - An ideal candidate would possess experience in prior authorization. - This is a remote opportunity, with hours of Monday-Friday 8AM-5PM, including Saturday rotations. - Must reside in AZ. - Your pay and benefits are important components... Banner Health offers a variety of benefits... - Banner Plans & Networks (BPN) description (maybe about the organization, could be included in About the role or separate? Could be part of About the role as context.) - Position Summary: This position provides support and execution of programs and tactics used to influence provider and health plan consumer/beneficiaries’ behaviors in order to achieve right care in the right place at the right time and the appropriate cost. Plans and provides support for health plan consumers/beneficiaries to align with the objectives of triple aim. This position is responsible to process health plan medical pre-service requests, provide case management, care coordination and perform utilization management duties within the appropriate time period as outlined in the Medical Management Program Descriptions, and in accordance with all federal and state regulations. We could incorporate Position Summary into About the role or Responsibilities. But we already have Responsibilities from Core Functions. Position Summary is more overview; could be part of About the role. We need to preserve all substantive info, not invent or summarize away detail. So we need to include the Position Summary text. We could add a separate section "Position Summary" but not in allowed headings list. The allowed headings are specific; we should stick to those. So we can incorporate Position Summary into About the role or Responsibilities. Probably About the role. Thus About the role will be a paragraph containing all that descriptive text (including Position Summary). Ensure we don't lose any detail. Let's craft About the role paragraph: "Banner Health is recognized as one of Becker’s Healthcare’s 150 top places to work in health care and appeared on Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity. In this role of RN Medical Management Services, you are required to be technologically savvy when researching plans using resources such as CMS, Noridian, Optum360 Encoder Pro (a provider lookup tool for contracted and noncontracted status) and more. You will review plans and receive case reviews via fax, with a non‑clinical team entering data into the system for determinations. Case variety is driven by the Prior Authorization Grid for services requiring review. You will phone providers, vendors, and members as needed within Banner’s processes. An ideal candidate possesses prior‑authorization experience. This is a remote position with Monday‑Friday 8 AM‑5 PM hours, including Saturday rotations, and requires residency in Arizona. The position supports Banner Plans & Networks (BPN), an accountable care organization that joins Banner Health with an extensive network of primary care and specialty physicians to deliver comprehensive healthcare solutions for Maricopa County and parts of Pinal County, collaborating to keep members healthy while reducing costs. The role provides support and execution of programs and tactics to influence provider and health‑plan consumer/beneficiary behaviors to achieve right care in the right place at the right time and appropriate cost, aligning with the triple aim. Responsibilities include processing health‑plan medical pre‑service requests, providing case management and care coordination, and performing utilization management duties per the Medical Management Program Descriptions and federal/state regulations." That seems to capture a lot. Now Responsibilities: Use Core Functions list. Let's extract Core Functions bullet points: - Manages health Plan consumer/beneficiaries’ across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes. - Provides pre-service determinations, concurrent review, and case management functions within Medical Management. - Ensures quality of service and consistent documentation. - Works collaboratively with both internal and external customers in assisting health Plan consumer/beneficiaries’ and providers with issues related to prior authorization, utilization management, and/or case management. - Meets internal and external customer service expectations regarding duties and professionalism. - Performs transfer of accurate, pertinent patient information to support the pre-service determination(s), the transition of patient care needs through the continuum of care, and performs follow-up calls for advanced care coordination. - Documents accurately and timely, all interventions and necessary patient related activities in the correct medical record. - Evaluates the medical necessity and appropriateness of care, optimizing health Plan consumer/beneficiaries’ outcomes. - Identifies issues that may delay patient services and refers to case management, when indicated to facilitate resolution of these issues, pre-service, concurrently and post-service. - Provides ongoing education to internal and external stakeholders that play a critical role in the continuum of care model. Training topics consist of population health management, evidence based practices, and all other topics that impact medical management functions. - Identifies and refers requests for services to the appropriate Medical Director and/or other physician clinical peer when guidelines are not clearly met. - Conducts call rotation for the health plan, as well as departmental call rotation for holiday. - Maintains a thorough understanding of each plan, including the Evidence of Coverage, Summary Plan Description authorization requirements, and all applicable federal, state and commercial criteria, such as CMS, MCG, and Hayes. - Has freedom to determine how to best accomplish functions within established procedures. - Confers with supervisor on any unusual situations. - Positions are entity based with no budgetary responsibility. - Internal customers: All levels of nursing management and staff, medical staff, and all other members of the interdisciplinary health care team. - External Customers: Physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies. We need to put these as- items. Now Requirements: Minimum Qualifications bullet points: - Requires Registered Nurse (R.N.) licensure in the state of practice. All license or certification must identify the issuing state or entity, type of licensure and expiration date or evidence that the certification is the type that does not expire. - A bachelor’s degree or equivalent experience. - Requires proficiency level typically achieved with five years of clinical experience. - Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management. - Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. - Must demonstrate ability to work effectively in an interdisciplinary team format. - Must be able to work flexible hours and take rotating call after hours. We'll list each as
- . Now Qualifications: Preferred Qualifications bullet points: - Certification(s) related to field, such as Certified Case Manager (CCM), MCG Certification(s), RN-BC Registered Nurse Case Manager, Certification in Managed Care Nursing (CMCN). - Additional Related Education And/or Experience Preferred. We'll list. Now Skills: Could extract from requirements: critical thinking, problem-solving, effective communication, time management, ability to work in interdisciplinary team, flexible hours, rotating call after hours. Also maybe "technologically savvy" etc. But we can keep as derived. We'll list those. Now Benefits: "Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do