Precert Clinical Specialist- RN License req

Temple University; Philadelphia (Philadelphia County); On-site; USD 49,000 - 80,000; Full time

Job summary

Temple University is seeking a Precert Clinical Specialist to serve as the clinical resource in the PreCertification Department. This full-time role requires a Registered Nurse to manage complex authorization issues, ensuring timely pre-certification processes and communication between departments. Join our dynamic healthcare team to enhance patient care and healthcare management while being part of a diverse and innovative work environment.

Qualifications

• 3 Years recent experience with Utilization Review in a hospital or insurance setting.
• 2 Years experience in Oncological Authorization/precertification preferred.
• RN-LIC - PA Registered Nurse License required.

Responsibilities

• Serves as primary clinical resource for handling complex authorization issues.
• Responsible for clinically assessing adverse determinations by insurers.
• Acts as liaison between Precertification Department and staff Physicians.

Skills

Utilization Review

Clinical Assessment

Authorization Issues

Education

Bachelor’s Degree in Nursing or other clinical healthcare field

Graduate of an accredited RN program

Job description

Join to apply for the Precert Clinical Specialist- RN License req role at Temple University

Serves as the primary clinical resource in the PreCertification Department for handling complex authorization issues. Responsible for clinically assessing all adverse determinations made by insurers through all levels of the Pre-Service Administrative appeals process. Supports the Patient Access team (both management and staff) to ensure precertification/authorization issues are investigated and handled expeditiously and thoughtfully from administrative, technical, and clinical perspectives. Acts as the primary liaison between the Precertification Department and staff Physicians regarding authorization issues. Supports the Infusion, Radiation Therapy, Surgical, and Diagnostic Imaging Precertification Teams. Reviews financial/insurance information obtained during the financial clearance process to ensure payer requirements are met by obtaining the appropriate referrals, pre-certification/authorization for payers to optimize reimbursement and avoid payment penalties.

Education
- Graduate of an accredited RN program (Required)
- Bachelor’s Degree in Nursing or other clinical healthcare field (Preferred)

Experience
- 3 Years recent experience with Utilization Review in a hospital or insurance setting (Required)
- 2 Years experience in Oncological Authorization/precertification (Preferred)
- General experience working with utilization review standards (Preferred)

License/Certifications
- RN-LIC - PA Registered Nurse License (Required)
- CPUR - Certified Professional Utilization Review (Preferred)

Temple Health is a dynamic network of hospitals, specialty centers, and physician practices, affiliated with the Lewis Katz School of Medicine at Temple University. We are committed to diversity, excellence, and innovation in healthcare. We are an Equal Opportunity Employer/Veterans/Disabled and welcome qualified applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status.

This job is listed as full-time, mid-senior level, in the healthcare industry, with a focus on health care provider roles within higher education settings. The location options include Elkins Park, PA, and Philadelphia, PA, with salary ranges from $49,900 to $80,000, depending on experience and role specifics.

Apply now to join our team and make a difference in patient care and healthcare management.