Pre- Authorization Coordinator - LPN or RN

Pre
- Authorization Coordinator - LPN or RN

• Employee Type Full-Time

Description

Strong understanding of clinical criteria and payer requirements

Effective communicator with experience collaborating across multidisciplinary teams

Demonstrated experience in utilization review, precertification, or case management

Proficiency in using Inter Qual criteria and working with payer authorization processes

Exceptional organizational and documentation skills

Preferred:
Background in nursing or health information management

At Baton Rouge General our patients aren’t the only people we take care of; we take care of our team too. We are proud to offer our employees the benefits and resources they need to be their best selves at work and at home.

A comprehensive benefits program for you and your family

Professional development and support

Various employee perks include generous paid time off, flexible positions, and our Baton Rouge General Fit! program

We are a nationally and locally recognized leader in quality and ranked one of the best healthcare employers in the state

Ensure appropriate utilization of clinical and financial resources by reviewing medical necessity for scheduled procedures, coordinating pre-authorizations, and working with physicians and payers to secure timely approvals and minimize denials.

Verify and collect necessary physician documentation prior to scheduled procedures

Review inpatient and observation cases using Inter Qual criteria to confirm medical necessity

Coordinate with physicians and internal teams to ensure proper admission level of care

Submit and manage authorization requests with external payers

Escalate complex cases to the Physician Advisor and facilitate peer‑to‑peer reviews as needed

Document level of care, authorization status, and payer communication in Allscripts

Assist in denial prevention and appeals processes by supporting proper documentation and timely communication

Communicate with Care Coordinators and Pre‑Authorization Coordinators to ensure streamlined case management

Send discharge notifications to payers and finalize authorizations at case closure

Track denial trends and participate in quality improvement efforts as directed by leadership

At Baton Rouge General, we are a community of compassionate, caring individuals who set the bar when it comes to healthcare excellence. Our mission is to preserve and restore health, one person at a time. From clinical to non‑clinical – what you do here matters.

With over 600 licensed beds between three campuses, Baton Rouge General offers the full spectrum of care from delivering newborns to providing end‑of‑life support through hospice. With clinics located throughout Baton Rouge and the surrounding areas, our physician group provides patients with comprehensive care and a full suite of specialties, including internal and family medicine and specialty care.

Required – 2 years nursing experience.

Preferred – 2 years clinical experience in case management

Required – High School Diploma or GED

Required – none

Required - Knowledge of ICD-9/10 coding and Inter Qual/MCG Criteria. Ability to organize and prioritize work for optimal results. Excellent analytical and problem‑solving skills