Clinical Resource Specialist

2 weeks ago


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

Position Overview

The Clinical Resource Specialist in the Pre-Certification Department plays a pivotal role in managing intricate authorization challenges. This position ensures that precertification and authorization matters are thoroughly investigated and resolved promptly, considering administrative, technical, and clinical aspects.

Key Responsibilities

  • Act as the primary liaison between the Pre-Certification Department and medical staff regarding authorization inquiries.
  • Review financial and insurance documentation to verify that payer requirements are satisfied by securing the necessary pre-certification and authorization.
  • Optimize reimbursement processes and mitigate payment penalties through effective management of authorization issues.

Educational Requirements

A Bachelor’s Degree in Nursing is required, or a commitment to obtain a BSN within four years of employment.

Graduation from an accredited nursing program is mandatory.

A Master’s Degree in Nursing is preferred.

Experience Requirements

A minimum of two years of recent experience in Utilization Review within a hospital or insurance environment is essential.

At least three years of experience in clinical acute care is required.

Preferred qualifications include general experience in Case Management, Utilization Review, and transition planning, as well as familiarity with utilization review standards.

Licenses and Certifications

Current RN License in Pennsylvania is required.

About Temple Health

Temple University Hospital is recognized nationally as a leading teaching hospital, situated on the vibrant Health Sciences Center campus of Temple University. The facility offers a wide range of healthcare services, from basic to complex, catering to patients locally, nationally, and internationally. As the primary clinical training site for the Lewis Katz School of Medicine at Temple University, the hospital fosters an environment dedicated to high-quality patient care, education, and innovative research.



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