Clinical Authorization Specialist

4 days ago


Philadelphia, Pennsylvania, United States Temple University Hospital Full time
Job Summary

We are seeking a highly skilled and experienced Registered Nurse to join our team as a Clinical Authorization Specialist in the Pre-Certification Department at Temple University Hospital. As a key member of our team, you will be responsible for ensuring that precertification/authorization issues are investigated and handled in a timely and thoughtful manner from an administrative, technical, and clinical perspective.

Key Responsibilities
  • Review financial/insurance information to determine payer requirements and obtain the necessary pre-certification/authorization to optimize reimbursement and avoid payment penalties.
  • Serve as the primary liaison between the Pre-Certification Department and staff Physicians in regard to authorization issues.
  • Investigate and resolve complex authorization issues in a timely and effective manner.
  • Collaborate with other departments to ensure seamless communication and coordination of patient care.
  • Stay up-to-date with changing regulations and guidelines related to precertification and authorization.
Requirements
  • Bachelor's degree in Nursing required within 4 years from date of hire.
  • 2 years of recent experience with Utilization Review in a hospital or insurance company setting.
  • 3 years of experience in clinical acute care.
  • General experience in Case Management, Utilization Review, and transition planning.
  • General experience in working with utilization review standards.
  • RN-LIC - PA Registered Nurse License.
Preferred Qualifications
  • Masters degree in Nursing or related field.
  • Experience in working with electronic health records and other clinical software systems.
What We Offer

Temple University Hospital offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced Registered Nurse looking for a challenging and rewarding role, we encourage you to apply.



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