Serves as the primary clinical resource in the Pre-certification Department for the handling of complex authorization issues. Ensures 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. Responsible for reviewing financial/insurance information to determine payer requirements are met by obtaining the appropriate pre-certification/authorization for payers in order to optimize reimbursement and avoid payment penalties. Bachelors degree in Nursing required within 4 years from date of hire.
Education
Bachelors Degree : in Nursing (BSN) or commitment to obtain BSN within 4 years from date of hire (Required)
Other : Graduate of an accredited school of nursing (Required)
Masters Degree (Preferred)
Experience
2 Years recent experience with Utilization Review in a hospital or in insurance company setting (Required)
3 Years experience in clinical acute care (Required)
General Experience in Case Management, Utilization Review and transition planning (Preferred)
General Experience in working with utilization review standards (Preferred)
License/Certifications
RN-LIC - PA Registered Nurse License (Required)
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, 10,000 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.
Your Tomorrow is Here!
Temple University Hospital is a nationally respected teaching hospital on Temple University's bustling Health Sciences Center campus. The hospital provides a comprehensive array of healthcare services both basic and complex to patients from around the corner, across the country and around the world. As the chief clinical training site for the Lewis Katz School of Medicine at Temple University, the hospital provides a dynamic environment for high-quality care, teaching, and cutting edge research.