RN - Registered Nurse - Clinical Access Specialist - Per Diem

Geisinger; Pennsylvania; Remote; USD 65,000 - 85,000; Full time

Job summary

Geisinger is seeking a Clinical Access Specialist RN to perform medical record reviews, ensuring compliance with certification requirements. This Per Diem role, allowing work-from-home flexibility in Pennsylvania, requires at least three years of RN experience with responsibilities including assessing medical necessity and working with third-party payer health plans.

Benefits

Health, dental and vision benefits starting on day one

401(k) plan with automatic contributions

Generous paid time off (PTO) policy

Tuition reimbursement up to $5,000 per year

Employee Assistance Program for various support

Qualifications

• At least three years of RN work experience required.
• Working knowledge of third-party payer health plans and regulations.
• Ability to perform medical necessity and level of care determination.

Responsibilities

• Review cases for medical necessity and compliance with regulations.
• Notify staff regarding discrepancies with health insurance coverage.
• Perform precertification and ensure documentation integrity.

Skills

Critical Thinking

Attention to Detail

Knowledge of Medical Necessity

Education

Registered Nurse (RN) License

Job description

The Clinical Access Specialist RN performs and ensures 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.

This role is Per Diem, varied hours and work from home in the state of PA. At least three (3) years of RN work experience is required.

• Identifies and notifies appropriate staff regarding discrepancy issues with third party payer health insurance coverage and lack of coverage.
• Maintains a working knowledge of third party payer health plans, working knowledge of nationally recognized review criteria and its application and state and federal regulations and mandates.
• Reviews cases, using standard parameters, in order to perform precertification requirements as indicated in third party payer contracts.
• Reviews all admission requests for appropriateness of level of care and compliance with third party pre-admission certification requirements, regulatory and standard ambulatory procedures.
• Requests additional clinical information and documentation when request does not meet medical necessity for level of care requested.
• Provides information, suggests alternatives and assists in ensuring documentation integrity.
• Enters utilization review data into database for tracking and trending audits, billing and reimbursement and Medicare compliance requirements.
• Reports serious events and incidents in accordance with established hospital policy and procedure.
• Attends to and ensures to the utmost integrity of the medical necessity chart review and application of review requirements.
• Acts a resource person for the healthcare team regarding third party payer health plan benefits for transition to next level of care or discharge to home.

Geisinger cares about not only its patients and members but also about you and your family. We offer a competitive compensation and benefits package to ensure that you and your loved ones can maintain good health, achieve financial stability, and excel both personally and professionally. We believe in creating a diverse and inclusive environment where all employees can be their authentic selves. To learn more: https://jobs.geisinger.org/diversity

Benefits of working at Geisinger:

• 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) anda 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, & pet care. Access 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

Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.