Clinical Lead, Prior Authorization (Home Health)
Company: Springfield Clinic
Location: Springfield
Posted on: May 30, 2025
Job Description:
The Clinical Lead, Prior Authorization is responsible for
performing all job duties as a patient service representative and
lead member of the team. To serve as a resource person and mentor
to the staff. The Clinical Lead, Prior Authorization is responsible
for collaborating with all members of the healthcare team.
Job Relationships
Reports to the Manager
Principal Responsibilities
- Function as a resource during the planning and implementation
of projects within the department.
- Assist the Managers with day-to-day planning and scheduling of
staff. Demonstrate willingness to provide staffing during critical
staffing times.
- Provide direct oversight and maintenance of department Quality
Assurance Pre-cert statistical information. Provide and summarize
clinical performance data to the as requested.
- Assist with development and maintenance of insurance
precertification policies and procedures in the TeleNurse
department.
- May serve as department preceptor.
- Must have an interest in technology and its applications for
improving patient care.
- Coordinate/lead the Insurance Precertification
Program.
- Stay up-to-date on insurance changes and requirements for
pre-certifications.
- Train staff on precertification program/processes and answer
their questions on a daily basis as needed.
- Act as a liaison with the physician offices, accept feedback,
and train Operations staff members as needed on
pre-certifications.
- Responsible for tracking all statistical precertification data.
Include tracking of revenue gain/loss for complete/incomplete
pre-certifications.
- Assist in curriculum development and coordinate the orientation
and training programs for new and experienced staff
members.
- Work collaboratively to coordinate educational In-services for
staff
- Assist in monitoring staff education compliance and completion
of mandatory requirements. Assist with the development of
department competencies.
- Prepare and present educational information to staff and
develop educational intranet site for within the
department.
- Comply with the Springfield Clinic incident reporting policy
and procedures.
- Adhere to all OSHA and Springfield Clinic training &
accomplishments as required per policy.
- Provide excellent customer service and adhere to Springfield
Clinic's Code of Conduct and Ethics Standards.
- Perform other job duties as assigned.
- Responsible for collaborating with all members of the
healthcare team to anticipate and address educational needs.
Education/Experience
- Minimum of three (3) years of clinical experience in an acute
ambulatory or acute care setting required.
- Experience and competency in training, evaluation, mentoring,
and project development preferred but not required.
- Experience with Prior authorizations preferred but not
required.
- Experience with healthcare clinical applications strongly
preferred.
Licenses/Certificates
- LPN license required within 90 days of hire
Knowledge, Skills and Abilities
- Ability to type at least 40 words per minute.
- Proficiency in Microsoft Word, PowerPoint, and Excel and strong
computer skills.
- Excellent written, verbal, and interpersonal communication
skills.
Working Environment
- Operates in a professional office environment with a potential
for work from home opportunities.
- Routinely uses standard office equipment such as computers,
phones
- Requires the ability to sit for extended periods.
PHI/Privacy Level
Keywords: Springfield Clinic, Florissant , Clinical Lead, Prior Authorization (Home Health), Healthcare , Springfield, Missouri
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