RN - Registered Nurse - Clinical Access Specialist - Per Diem

About the Role

As one of the Top 8 Most Innovative Healthcare Systems in Becker’s Hospital Review, we’re working to create a national model for improving health. Through professional growth, quality improvement, and interdisciplinary collaboration, we’ve built an innovative culture that allows nurses to grow their skillsets, develop their practice, and leverage their years of experience to build a rewarding, lasting career with impact.

This role is per diem with varied hours, including weekdays and weekends.

Responsibilities

• Perform and ensure adherence to state, federal, and third-party payer certification requirements for initial, concurrent, and retrospective medical record review for medical necessity and level of care determination.
• Identify and notify appropriate staff regarding discrepancy issues with third-party payer health insurance coverage and lack of coverage.
• Maintain a working knowledge of third-party payer health plans, nationally recognized review criteria, and state and federal regulations and mandates.
• Review cases using standard parameters to perform precertification requirements as indicated in third-party payer contracts.
• Review all admission requests for appropriateness of level of care and compliance with third-party pre-admission certification requirements, regulatory, and standard ambulatory procedures.
• Request additional clinical information and documentation when a request does not meet medical necessity for the level of care requested.
• Provide information, suggest alternatives, and assist in ensuring documentation integrity.
• Enter utilization review data into a database for tracking and trending audits, billing, reimbursement, and Medicare compliance requirements.
• Report serious events and incidents in accordance with established hospital policy and procedure.
• Ensure the utmost integrity of medical necessity chart review and application of review requirements.
• Act as a resource person for the healthcare team regarding third-party payer health plan benefits for transition to the next level of care or discharge to home.

Requirements

• Minimum of three (3) years of RN work experience.
• Previous experience in an acute care setting is preferred.
• Previous Utilization Management experience is highly preferred.
• BSN is preferred.
• Licensed Registered Nurse (RN) in the State of Pennsylvania.

Benefits

• Full benefits (health, dental, and vision) starting on day one.
• Three medical plan choices, including an expanded network for out-of-area employees and dependents.
• Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA).
• Company-paid life insurance, short-term disability, and long-term disability coverage.
• 401(k) plan that includes automatic Geisinger contributions.
• Generous paid time off (PTO) plan that allows you to accrue time quickly.
• Up to $5,000 in tuition reimbursement per calendar year.
• MyHealth Rewards wellness program to improve your health while earning a financial incentive.
• Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay, and a free Care.com membership with discounted backup care for your loved ones.
• Employee Assistance Program (EAP): Referrals for childcare, eldercare, and pet care. Access to free legal guidance, mental health visits, work-life support, digital self-help tools, and more.
• Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life, and pet and legal insurance.

Position Details

Work is typically performed in a clinical environment. Accountable for satisfying all job-specific obligations and complying with all organization policies and procedures.

Education: Graduate from a Specialty Training Program in Nursing (Required).