Pre-Certification - Registered Nurse

Lehigh Valley Hospital, Inc.; Allentown (Lehigh County); Remote; USD 60,000 - 100,000; Full time

Job summary

Join a forward-thinking health care organization recognized for excellence and innovation. This role involves screening inpatient and ambulatory reservations, ensuring insurance approvals, and collaborating with physician offices to gather necessary clinical information. With a focus on patient care and compliance, you will be part of a dedicated team committed to delivering the highest quality of health services. If you are passionate about making a difference in health care and thrive in a dynamic environment, this opportunity is perfect for you.

Qualifications

• 5 years of experience in pre-certification and utilization management.
• Must be adept at using computerized insurance verification systems.

Responsibilities

• Screens reservations for insurance approval and appropriate care level.
• Communicates with departments and insurance companies for compliance.

Skills

Assessment Skills

Insurance Verification

Communication Skills

Self-direction

Education

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing

Tools

Computerized Insurance Verification Systems

Job description

Lehigh Valley Health Network (LVHN) is home to nearly 23,000 colleagues who make up our talented, vibrant and diverse workforce.

Join our team and experience firsthand what it's like to be part of a health care organization that's nationally recognized, forward-thinking and offers plenty of opportunity to do great work.

Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

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.

Job Duties

• 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.

Minimum 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.
• Must be adept at using various computerized insurance verification systems.
• Must be knowledgeable in health insurance requirement.
• Must have good assessment skills to make appropriate referrals.
• Must be 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.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy.

Location

REMOTE IN PENNSYLVANIA

1200 S Cedar Crest Blvd, 18103, Allentown, United States

Job Category: RN - Registered Nurse

Night Shift, Sunday -Saturday 1900-0730 rotating weekends and holidays

Job ID: wd-JR119941

Posted: March 18, 2025