Job Description - Pre-Certification RN- (TUH/Day Shift) (240728)
Serves as the primary clinical resource in the Pre-certification Department for the handling of complex authorization issues. Ensures precertification/authorization issues are investigated and handled expeditiously and thoughtfully from an administrative, technical, and clinical perspective. Serves as the primary liaison between the Precertification Department and staff Physicians regarding authorization issues. Responsible for reviewing financial/insurance information to determine payer requirements are met by obtaining the appropriate pre-certification/authorization for payers in order to optimize reimbursement and avoid payment penalties.
Education
- Bachelors Degree: in Nursing (BSN) or commitment to obtain BSN within 4 years from date of hire (Required)
- Other: Graduate of an accredited school of nursing (Required)
- Masters Degree (Preferred)
Experience
- 2 Years recent experience with Utilization Review in a hospital or insurance company setting (Required)
- 3 Years experience in clinical acute care (Required)
- General Experience in Case Management, Utilization Review, and transition planning (Preferred)
- General Experience in working with utilization review standards (Preferred)
License/Certifications
- RN-LIC - PA Registered Nurse License (Required)
Equal Opportunity Employer/Veterans/Disabled
An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
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