RN - Registered Nurse - Clinical Access Specialist - Per Diem

Geisinger•Work from home (Pennsylvania), PA

1d•Remote

About The Position

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. Today, we’re focused on bringing our region services that improve every facet of life to drive total health, inside and out. 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.

Requirements

At least three (3) years of RN work experience is required.
Graduate from Specialty Training Program-Nursing (Required)
Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania

Nice To Haves

Previous experience in an acute care setting is preferred.
Previous Utilization Management experience is highly preferred.
BSN is preferred.

Responsibilities

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.
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.

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, & 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
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
We encourage an atmosphere of collaboration, cooperation and collegiality.
We know that a diverse workforce with unique experiences and backgrounds makes our team stronger.
We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.