Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services Proposed Minimum Salary Commensurate Job Location College Station, Texas Job Type Staff Job Description Our Commitment Texas A&M University is committed to enriching the learning and working environment by promoting a culture th at respects all pers p ectives, talents & lived experience s . Embracing varying opinions and perspectives strengthens our corevalues which are: Respect, Excellence, Leadership, Loyalty, Integrity, and Selfless Service . Who we are As one of the fastest-growing academic health centers in the n at ion, Texas A&M Health encompasses five colleges and numerous centers and institutes working together to improve health through transform at ive educ at ion, innov at ive research and team-based health care delivery. What we want The Registered Nurse II-Prior Authorization and Referral, under general supervision, manages administrative functions related to prior authorizations and referrals. Ensures students receive timely access to specialty care, medications, and diagnostic procedures by managing complex prior authorization processes and coordinating follow- up activities. What you need to know Salary: will be commensur at e based on the selected hire’s educ at ion and experience. Special Instructions: A cover letter, resume, and contact inform at ion for three professional references (to include at least one previous supervisor) are strongly recommended. You may upload all three on the applic at ion under CV/Resume or upon answering the questionnaire you may at tach the documents. Qualifications Required Education and Experience + Associate Degree in Nursing + Two years of experience as a Registered Nurse, including experience in at least one of the following areas: Prior authorizations or utilization management , c are coordination or case management , i nsurance or payer policy navigation , o utpatient clinic operations or referral processing , r eviewing medical documentation for insurance or compliance purposes , w orking in a college health, primary care, or ambulatory care setting. Required Licenses and Certifications: + Must be licensed by the State of Texas as a Registered Nurse. + CPR certified. Preferred Qualifications: + Bachelor's degree in nursing. + Five years of experience as a Registered Nurse, including experience in at least one of the following areas: p rior authorizations or utilization management, care coordination or case management, insurance or payer policy navigation, outpatient clinic operations or referral processing, reviewing medical documentation for insurance or compliance purposes, working in a college health, primary care, or ambulatory care setting. Responsibilities Prior Authorizations & Care Coordination + Reviews and processes prior authorizations for medications, radiology procedures, and specialty services. + Navigates payer policies including step therapy protocols, quantity limits, preferred drug lists, and therapeutic substitutions. + Assists patients and providers in identifying and applying for patient assistance programs or financial assistance when available. + Facilitate peer-to-peer reviews with payers when pre-authorizations are denied. + Collaborate with providers to gather necessary clinical documentation and address denials or escalations. + Tracks status of authorizations and manages related communications with patients and staff. Referral Management + Coordinates external referrals to specialty providers, ensuring completeness of documentation and timely submission. + Follow up with external offices, providers, and students to support continuity of care. + Maintains accurate tracking and communication regarding referral outcomes. Patient Care and Education + Educates patients on referral processes, coverage details, and treatment plans. + Documents clinical and administrative activities in the electronic medical record. Clinical Operations + Supports day-to-day operations in the clinic, assists in scheduling and patient flow. + Helps ensure compliance with healthcare regulations and university policies. Resourcing and Quality Improvement + Serves as a resource for nursing and administrative staff on prior authorization and referral policies. + Participates in the development and implementation of workflow improvements related to access and coordination of care. Knowledge, Skills, and Abilities: + Knowledge of standard nursing procedures and techniques. + Strong understanding of insurance guidelines and prior authorization processes. + Ability to review and interpret clinical documentation to determine what is required for prior authorizations and referrals. + High level of comfort with computers, databases, and web-based systems; able to independently navigate payer portals, referral platforms, and electronic records systems. + Excellent organizational, communication, and problem-solving skills. + Ability to multitask and work cooperatively with others. + Ability to handle sensitive information and maintain confidentiality. + Proficiency in documenting and navigating electronic medical records. Other Requirements and Factors: + The individual in this position may be required to handle Personally Identifiable Information1 (PII) as defined by Family Educational Rights and Privacy Act (FERPA) (https://studentprivacy.ed.gov/ferpa) regulations and Protected Health Information2 (PHI) as defined by Health Insurance Portability and Accountability Act (HIPAA) (https://www.hhs.gov/hipaa/for-professionals/privacy/index.html) regulations. The individual is required to handle PII and PHI in accordance with University Health Services (UHS), Texas A&M University System policies, and all applicable federal regulations + - 1PII includes information that can be used to distinguish or trace an individual’s identity, either alone or when combined with other personal or identifying information. + - 2 PHI refers to any health information that can be linked to a specific individual and is protected under federal privacy regulations. + FERPA and HIPAA training are required upon employment and must be completed on a recurring basis as determined by policy and job duties. Why Texas A&M University? We are a prestigious university with strong traditions, Core Values, and a community of caring and collaboration.  Amenities associated with a major university, such as sporting and cultural events, state-of-the-art recreation facilities, the Bush Library and Museum, and much more await you.  Experience all that a big city has to offer but with a reasonable cost-of-living and no long commutes.  + Medical, (https://www.tamus.edu/benefits/medical/) prescription drug, dental, (https://www.tamus.edu/benefits/dental/) vision, life and AD&D, (https://www.tamus.edu/benefits/life-add/) flexible spending accounts , and long-term disability insurance (https://www.tamus.edu/benefits/long-term-disability/) with Texas A&M contributing to employee health and basic life premiums + 12-15 days (https://employees.tamu.edu/employee-relations/leave/index.html) of annual paid holidays + Up to eight hours of paid sick leave (https://employees.tamu.edu/employee-relations/leave/paid/sick.html)  and at least  eight hours of paid vacation (https://employees.tamu.edu/employee-relations/leave/paid/vacation.html)  each month + Automatic enrollment in the  Teacher Retirement System of Texas (https://www.trs.texas.gov/Pages/Homepage.aspx) + Health and Wellness: Free exercise programs and release time (https://flourish.tamu.edu/wellness-release-time/) + Professional Development: All employees have access to free  LinkedIn Learning (https://linkedinlearning.tamu.edu/)  training, webinars, and limited financial support to attend conferences, workshops, and more + Educational release time and tuition assistance (https://livingwell.tamu.edu/employee-tuition-assistance)  for completing a degree while a Texas A&M employee + Living Well, (https://livingwell.tamu.edu/) a program at Texas A&M that has been built by employees, for employees Instructions to Applicants: Applications received by Texas A&M University must either have all job application data entered or a resume attached. Failure to provide all job application data or a complete resume could result in an invalid submission and a rejected application. We encourage all applicants to upload a resume’ or use a LinkedIn profile to pre-populate the online application. All positions are security-sensitive. Applicants are subject to a criminal history investigation, and employment is contingent upon the institution’s verification of credentials and/or other information required by the institution’s procedures, including the completion of the criminal history check. Equal Opportunity/Veterans/Disability Employer.