The LPN/RN is a critical member of the general surgery team, responsible for delivering patient care, managing authorization processes for advanced imaging, procedures, and surgeries, and performing peer-to-peer reviews with insurance companies to appeal and reverse denials. This role ensures seamless coordination between patients, providers, and external facilities while upholding high standards of nursing care.
Graduate of an accredited nursing program. Current unrestricted LPN or RN license in Mississippi. BLS certificationrequired .
Minimum of three years of clinical nursing experience.
Previousexperience with prior authorizations, appeals, and peer-to-peer reviewsstronglypreferred.
& Responsibilities Obtain andsubmitprior authorizations for surgeries and advanced imagingstudiesincluding MRIs and CT scans. Perform peer-to-peer reviews with insurance companies to appeal and reverse denials. Maintainaccuratedocumentation of authorization requests, approvals, and appeals in the EMR.
Perform patient assessments including vital signs and pain evaluations. Educate patientsregardingconditions, procedures, and recovery expectations. Assistproviders with wound care, suture removal, and other office procedures.
Serve as a liaison between patients, providers, insurance companies, and external facilities. Maintain organized records of authorizations, appeals, and approvals for compliance and reporting purposes. Adhere to clinic policies, infection control standards, and HIPAA regulations.
Maintain current certifications andparticipatein ongoing education. Professional Responsibilities Demonstrate strong organizational and time management skills. Communicate effectively with patients, providers, and insurance representatives.
Advocate for patients during authorization andappealsprocesses. Utilize EMR systems and prior authorization platforms effectively. Maintain compliance with organizational policies and regulatory requirements.
Physical Requirements Occasional lifting of medical equipment or supplies up to 25 pounds. Ability to multitask in a fast-paced clinical environment. Frequent standing, walking, patient interaction, and computer use.
All candidates must be able to perform the essential functions of this position. The Americans with Disabilities Act (ADA) requires that reasonable accommodations be made for qualified individuals to help perform the essential functions of the position. South Central Regional Medical Center is an equal opportunity employer and does not discriminate based on race, color, religion, sex, gender, national origin, age, disability, or genetic information.