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Pre-Certification - Registered Nurse
Location
United States
Posted
5 days ago
Salary
Not specified
Seniority
Mid Level
No structured requirement data.
Job Description
Role Description
Screens inpatient and ambulatory reservations to ensure that insurance approval has been obtained and the patient is scheduled for the appropriate level of care. Calls physician offices to verify/obtain additional clinical information and insurance authorizations/referrals.
- Obtains insurance verification and precertification for approval.
- Communicates with other hospital departments, physician offices, and insurance companies to ensure hospital compliance with medical necessity and pre-certification requirements.
- Keeps informed of regulatory requirements and changes concerning medical, medical assistance, and other third-party payors.
- Maintains updated precertification information and distributes to pre-cert team and appropriate departments.
- Screens inpatient and ambulatory reservations to determine level of care and obtains insurance approval.
- Refers questionable situations to the manager and/or director of pre-certification as needed.
- Seeks out the physician advisor for review and/or action involving rescheduling or cancellation of services.
Qualifications
- Associate’s Degree in nursing, healthcare administration or healthcare related field.
- 5 years of experience in pre-certification and utilization management review.
- 3 years experience in the nursing field.
- Adept at using various computerized insurance verification systems.
- Knowledgeable in health insurance requirements.
- Good assessment skills to make appropriate referrals.
- Self-directed and able to prioritize duties within a rapidly changing environment.
- RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire.
Preferred Qualifications
- Bachelor’s Degree in nursing, healthcare administration or healthcare related field.
Physical Demands
- Lift and carry 25 lbs.
- Frequent sitting/standing.
- Frequent keyboard use.
- Patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
Work Schedule
- Day Shift
- Mon-Fri 8-4:30
Address
- 1200 S Cedar Crest Blvd
- Primary Location: REMOTE IN PENNSYLVANIA
Department
- 1004-13036 COH-Precertification Dept
Job Requirements
- Associate’s Degree in nursing, healthcare administration or healthcare related field.
- 5 years of experience in pre-certification and utilization management review.
- 3 years experience in the nursing field.
- Adept at using various computerized insurance verification systems.
- Knowledgeable in health insurance requirements.
- Good assessment skills to make appropriate referrals.
- Self-directed and able to prioritize duties within a rapidly changing environment.
- RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire.
- Preferred Qualifications
- Bachelor’s Degree in nursing, healthcare administration or healthcare related field.
- Physical Demands
- Lift and carry 25 lbs.
- Frequent sitting/standing.
- Frequent keyboard use.
- Patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
- Work Schedule
- Day Shift
- Mon-Fri 8-4:30
- Address
- 1200 S Cedar Crest Blvd
- Primary Location: REMOTE IN PENNSYLVANIA
- Department
- 1004-13036 COH-Precertification Dept
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