Pre-Certification - Registered Nurse

Lehigh Valley Health Network

9d • Remote

About The Position

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.

Requirements

• 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.
• Must be knowledgeable in health insurance requirements.
• RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire

Nice To Haves

• Bachelor’s Degree in nursing, healthcare administration or healthcare related field.

Responsibilities

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree