Clinical Research Nurse Hourly

Jefferson Health Plans•Philadelphia, PA

4d•Onsite

About The Position

Performs basic nursing skills, study coordination, and data management, focusing on subject recruitment and enrollment, consistent study implementation, data integrity, and compliance with regulatory requirements and reporting. The role collects clinical information from participants, provides study education, obtains informed consent, and supports clinical-trial enrollment. It also coordinates communication, meetings, and progress tracking with consortium members and participating institutions. Additional duties may include collecting and processing specimen tissue, organizing research data, collaborating with the research team on goals and objectives, and supporting adherence to study protocols. The job description also includes extensive case-management, utilization-review, discharge-planning, and appeal-related duties, including applying medical-necessity criteria, documenting reviews, coordinating safe transitions of care, and referring cases to a Physician Advisor when needed.

Requirements

Associate’s Degree in Nursing or nursing diploma; a Bachelor’s Degree in Nursing is also listed in the minimum qualifications.
At least 1 year of RN clinical experience in a healthcare setting.
3 years of case management, discharge planning, or utilization management experience.
Knowledge of managed care and governmental and third-party payor reimbursement.
Proficiency with InterQual and MCG criteria and their application.
Strong interpersonal skills and the ability to prioritize workload, meet multiple deadlines collaboratively, communicate effectively orally and in writing, work in a team, and document in electronic health records.
Knowledge of medical, social, economic, and other services provided by departments or facilities, and ability to integrate multidisciplinary treatments for patient care.
Knowledge of legislation and regulatory bodies affecting healthcare practices.
Ability to work constructively and collaboratively with a variety of individuals and groups, and to manage concurrent objectives, projects, groups, or activities while prioritizing and allocating time effectively.
Pennsylvania Registered Nurse license.
Ability to lift and carry 40–50 pounds; frequent to continuous standing and walking; and role-related activities may include kneeling, bending, squatting, and performing CPR.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
Less than 1 year of research experience preferred.
Certification in InterQual criteria.

Responsibilities

Collect and document clinical information from study participants.
Provide patient education regarding research studies.
Obtain informed consent and support enrollment in clinical trials.
Interact with consortium members and participating institutions; organize and schedule meetings, track progress, and record and distribute meeting minutes.
Work with the research team to identify, develop, implement, and evaluate goals and objectives; support adherence to protocol guidelines and organize research data.
May collect and process specimen tissue for analysis by technical personnel.
Apply medical-necessity criteria and determine appropriate patient status within 24 hours of admission.
Complete retrospective clinical reviews for cases requiring third-party payor medical-necessity approval and document applicable criteria and level-of-care guidelines.
Evaluate appeal outcomes and retrospective denials, conduct appeal processes, research clinical aspects of cases, and refer cases to the Physician Advisor when required.
Follow procedures for Condition 44 downgrades, IRO appeals, third-party payor protocols, and governmental payer processes.
Track Medicare admissions requiring review and document in medical records and work queues according to policy.
Identify recurring denial and appeal issues and report them to the Manager.
Use an interdisciplinary team approach to patient care planning and discharge coordination; communicate discharge plans and transfer medical information to patients, families, and external providers or facilities.
Assess and anticipate discharge-planning needs and involve patients, families, or guardians in decisions about transitions to the next level of care.
Recognize signs of physical or emotional abuse or neglect and follow reporting procedures.
Adhere to organizational policies, payer-contract workflows, and governmental payer processes.