Registered Nurse - Clinical Access Specialist - Per Diem

Previous experience in an acute care setting is preferred.

Previous Utilization Management experience is highly preferred.

BSN is preferred.

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.

Benefits of working at Geisinger

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. 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 Position Details

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.

Responsibilities Education

Graduate from Specialty Training Program-Nursing (Required)

Experience

Minimum of 3 years-Nursing (Required)

Certification(s) and License(s)

Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania