The Prior Authorization Coordinator will review and evaluate outpatient take-home medications to assure the appropriateness and medical necessity of medication use based on established criteria, and obtain prior authorization from intermediaries and payers, including managed care companies, insurance companies, and review organizations.

The Nurse Manager assumes primary leadership and management of defined clinical nursing areas to facilitate and deliver comprehensive quality nursing care and to manage the environment in which care is given. Major functions include: goals, planning, customer service/marketing, standards, certification and accreditation, administrative management, budget/cost containment, communication, and education. Ensures adherence to hospital or department and university policies and to nursing policies, procedures, standards, and practices. The Nurse Manager exemplifies the Upstate mission, vision, and values and acts in accordance with Upstate policies and procedures.

The Outpatient Administrative Specialist will provide clinical administrative support to the assigned ambulatory area.  May assist in the preparation of monthly report of activities by compiling statistical data relative to clinic services as needed or requested. Serves as a subject matter expert and resource for providers and staff, addressing all non-routine issues and concerns related to the referral and authorization process. Assist with patient check-in and check-out procedures including registration activities such as entering and/or verifying demographic, insurance and/or financial information; generates routine forms and other documentation. Manage the EPIC Referral WQs. Answers phone, prioritizes incoming mail, faxes and correspondence. Work with/advise patients on insurance carrier requirements including services not covered and obtains documentation, collects patient co-pays, etc. Applies understanding of the need for ABN's and Waiver of Liability patient signatures. Obtains insurance authorizations, referrals, and manages denial processes in an accurate and efficient manner. Accepts assignments to other areas and performs additional administrative support duties as assigned.