Jelly Nurse: Prior Authorization (CMA or LPN)

Description

 The Jelly Nurse provides nursing care to patients as delegated by a supervisor, a role that combines both clinical and administrative duties. Core responsibilities include triaging patients over the phone, managing medication refills, and providing support for non-urgent patient education. The position also requires significant administrative work, such as reviewing provider schedules to prep charts in advance of visits , tracking incoming lab results & reports, and completing patient paperwork for FMLA, disability, and prior authorizations. Furthermore, the Jelly Nurse supports physicians and midlevel providers with documentation needs and helps maintain clinic efficiency by monitoring the pace and flow to anticipate and assist with delays. 

Jelly Nurse Responsibilities 

• Provides nursing care to patients and as delegated by assigned supervisor and/or provider in order to meet the needs of the patient/family  
• Team members are assigned to one primary internal functional lane based on clinic need and skill set: Clinic Runner, Prior Authorizations, or Phone Room.  
• Cross-coverage may be requested as operationally needed. 

Prior Authorization Responsibilities 

• Primary party responsible for medication therapy prior authorizations and related payer requirements for Dr. Champion’s clinic/patient needs as assigned  
• Submits complete prior authorization requests through payer portals/phone/fax as required and follows up consistently on pending cases through resolution  
• Completes patient assistance and coordinates resulting medication deliveries with the patient(s) or their caregiver(s) when applicable  
• Effectively and respectfully communicates with other departments of the office via all methods and documents appropriately in the EMR  
• Demonstrates strong written/verbal communication skills and EMR/computer skills to ensure accurate documentation and timely processing  
• Independently completes assignments in a timely manner and escalates barriers that risk patient delays (e.g., missing documentation, denials, urgent clinical need) 

Requirements

Education and Qualifications 

• Holds/maintains active CMA license or Holds/maintains active LPN license, active in Georgia  
• Holds/maintains a current MA certification and maintain Basic Life Support (BLS) 
• Minimum 1 year of healthcare experience, preferably in outpatient setting with working cardiac knowledge preferred 

 Full-Time Benefits & Perks 

• Set scheduled 4-day work week 
• Comprehensive Medical, Dental, and Vision insurance (effective 1st of the month following 60 days) 
• Company-paid Long-Term Disability (60%) and $25,000 Basic Life Insurance 
• 6 Paid Holidays: New Year’s Day, Memorial Day, 4 of July, Labor Day, Thanksgiving, & Christmas 
• PTO accrued at 3.08 hours per paycheck (80 hrs/yr) 
• 401k matching program after 1 year worked 
• VIP Status at both Southeastern Cardiology and Southeastern Gastroenterology 
• Discounts through Uniforms of America, and the Working Advantage program.