RN - Pre-Certification

1 month ago


Philadelphia, United States Temple Health – Temple University Health System Full time

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 expeditious and thoughtfully from an administrative, technical and clinical perspectives. Serves as the primary liaison between the Precertification Department and staff Physicians in regard to 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. Bachelors degree in Nursing required within 4 years from date of hire.


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 in 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)



Your Tomorrow is Here


Temple University Hospital is a nationally respected teaching hospital on Temple University's bustling Health Sciences Center campus. The hospital provides a comprehensive array of healthcare services both basic and complex to patients from around the corner, across the country and around the world. As the chief clinical training site for the Lewis Katz School of Medicine at Temple University, the hospital provides a dynamic environment for high-quality care, teaching, and cutting edge research.



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