Registered Nurse (RN) - Med Surg
Temple University Hospital
Philadelphia, PA

Pre-Certification RN- (TUH/Day Shift)

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) _ '239909