Precert Clinical Specialist- RN License req

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profile Job Location:

Philadelphia, PA - USA

profile Monthly Salary: Not Disclosed
Posted on: Yesterday
Vacancies: 1 Vacancy

Department:

Finance

Job Summary

Your Tomorrow is Here!


Temple Health is committed to setting new standards for preventing diagnosing and treating major diseases in our community and across the nation. Achieving that goal means investing in our employees success through staff and leadership development. Our recruitment strategy is to attract and retain a diverse high performing workforce that fosters a healthy safe and productive environment for our patients and colleagues alike.

Serves as the primary clinical resource in the PreCertification Department for the handling of complex authorization issues. Responsible for clinically assessing all adverse determinations made by insurers through all levels of the Pre-Service Administrative appeals process. Supports the Patient Access team (both management and staff) to ensure 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. Supports the Infusion Radiation Therapy Surgical and Diagnostic Imaging Precertification Teams. Responsible for reviewing financial/insurance information obtained during the financial clearance process to determine payer requirements are met by obtaining the appropriate referrals pre-certification/authorization for payers in order to optimize reimbursement and avoid payment penalties.

Education
Other Graduate of an accredited RN program Required
Bachelors Degree Nursing or other clinical health care field Preferred

Experience
3 years recent experience with Utilization Review in a hospital or in insurance company setting Required
2 years experience in oncological authorization/precertification Preferred
General Experience in working with utilization review standards Preferred

Licenses
PA Registered Nurse License Required
Cert Prof Utilization Review Preferred

Your Tomorrow is Here!


Temple Health is a dynamic network of outstanding hospitals specialty centers and physician practices that is advancing the fight against disease pushing the boundaries of medical science and educating future healthcare professionals. Temple Health consists of Temple University Hospital (TUH) Fox Chase Cancer Center TUH-Jeanes Campus TUH-Episcopal Campus TUH-Northeastern Campus Temple Physicians Inc. and Temple Transport Team. Temple Health is proudly affiliated with the Lewis Katz School of Medicine at Temple University.

To support this mission Temple Health is continuously recruiting top talent to join its diverse 10000 strong workforce that fosters a healthy safe and productive environment for its patients visitors students and colleagues alike. At Temple Health your tomorrow is here!

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.


Required Experience:

IC

Your Tomorrow is Here!Temple Health is committed to setting new standards for preventing diagnosing and treating major diseases in our community and across the nation. Achieving that goal means investing in our employees success through staff and leadership development. Our recruitment strategy is t...
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Key Skills

  • Sales Experience
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  • Communication skills
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  • Microsoft Word
  • Case Management
  • OSHA
  • Team Management
  • Catheterization
  • Microsoft Outlook Calendar
  • EHS

About Company

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Temple Health is a major Philadelphia-based academic health system that is driving medical advances through clinical innovation, pioneering research and world-class education.

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