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Clinical Authorization Specialist

2 months ago

Philadelphia, Pennsylvania, United States Temple University Hospital Full time
Position Overview:
As a Clinical Authorization Specialist, you will play a crucial role in the Pre-certification Department, acting as the main clinical resource for complex authorization matters. Your expertise will ensure that precertification and authorization challenges are addressed promptly and thoughtfully, considering administrative, technical, and clinical aspects.

Key Responsibilities:
1. Serve as the primary liaison between the Pre-certification Department and medical staff regarding authorization inquiries.
2. Review financial and insurance data to ascertain that payer requirements are fulfilled by securing the necessary pre-certification and authorization, thereby enhancing reimbursement and mitigating payment penalties.

Qualifications:
Education:
- Bachelor’s Degree in Nursing (BSN) or a commitment to obtain a BSN within four years of hire (Required)
- Graduate of an accredited nursing program (Required)
- Master’s Degree (Preferred)

Experience:
- Minimum of 2 years of recent experience in Utilization Review within a hospital or insurance environment (Required)
- At least 3 years of experience in clinical acute care (Required)
- General experience in Case Management, Utilization Review, and transition planning (Preferred)
- Familiarity with utilization review standards (Preferred)

Licenses/Certifications:
- Valid PA Registered Nurse License (Required)