Registered Nurse Case Manager - Medication Prior Auth

Pay Range: $38.93 - $54.76

SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.

Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health, dental, and vision benefits, life insurance and long and short-term disability, and more.

This position functions within the nursing department and is responsible for coordinating the delivery of appropriate and timely care for patients, promoting quality, and cost-effective health care outcomes.

• Active management of SEARHC patients.

• Collaborates with medical providers and interdisciplinary team members to establish individualized medical goals that maximize patient healthcare outcomes.

• Coordinates multi-disciplinary care conferences for high-risk or complex patients referred into the case management process.

• Manages panel acute and chronic care needs as well as health maintenance, by continuously reviewing EHR reminders and triggers and providing outreach and education to patients.

• Participates in case management reviews for high-need patients with a multi-disciplinary team.

• Advocates for patient/client family at the service-delivery level, fostering decision making, independence, self-care, and growth.

• Uses problem-solving and anticipatory skills to meet patient and provider needs in a prompt, efficient manner.

• Facilitates coordination of patient referrals within SEARHC and outside facilities. Tracks progress and outcomes, providing periodic status reports to providers.

• Serves as the primary link for other case managers and discharge coordinators in care coordination.

• Proactively identifies delays and obstacles to care and works to remedy individual cases and improve processes.

• Performs staff nursing duties in various clinic roles, including assessment, documentation, education, and administering medications/therapies.

• Maintains annual competencies including safety and infection control requirements.

• Promotes effective nursing staff relationships and maintains a clean, safe working environment.

• Adheres to infection control policy and procedures.

• Builds bridges and creates rapport with team members within departments and across the organization.

• Participates in department and clinic team improvement efforts.

• Active member and leader among the clinical team, nursing staff, and unit coordinators.

• Participates in continued development of the case management role in primary care.

• Participates in triage and responds to emergency situations.

• Performs other duties as assigned, including special projects to provide comprehensive health services.

• Facilitates coordination of specialty clinic referrals.

• Manages referrals and waitlists.

• Reviews referrals for appropriateness and completion of work‑up labs/diagnostics.

• Consults with referring providers for questions or concerns.

• Schedules patients in requested clinics based on priority.

• Ensures pre‑appointment diagnostics are ordered, scheduled, and completed.

• Coordinates with other facilities for clinic availability.

• Tracks progress and outcomes of referrals, providing periodic status reports.

• Ensures referral records are received and available for provider review.

• Provides clinical support for all specialty clinics, including assessment, documentation, education, and administering medications/therapies.

• Prepares clinical space and assists providers during medical procedures.

• Assists medical staff with educational in‑services provided by specialty clinic providers.

• Coordinates and manages the prior authorization process for patient referrals, procedures, medications, and treatments.

• Reviews clinical documentation to ensure all necessary information is included for authorization requests.

• Communicates with providers, payers, and patients to facilitate timely approvals and resolve issues or denials.

• Trac…