RN – Registered Nurse, Clinical Access Specialist

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🔥 5 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Geisinger

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1915

💊 Pharmaceuticals

🧘 Wellness

Healthcare • Pharmaceuticals • Wellness

Geisinger is a healthcare organization that has been providing accessible medical services for over a century in Pennsylvania. It focuses on meeting the healthcare needs of its communities and is dedicated to innovative patient care. With career opportunities in various fields including nursing, allied health, and administration, Geisinger promotes professional development and a supportive workplace for its employees, emphasizing diversity, equity, and inclusion.

📋 Description

• performs utilization review, medical necessity assessments, and authorization activities to promote quality outcomes, timely reimbursement, and effective care transitions • reviewing clinical documentation, verifying coverage and certification requirements • collaborating with physicians and care teams • maintaining accurate utilization review records, supporting documentation integrity, and ensuring compliance with state, federal, and third-party payer standards • identifying and notifying appropriate staff regarding discrepancy issues with third party payer health insurance coverage and lack of coverage

🎯 Requirements

• At least three (3) years of RN work experience is required • Previous experience in an acute care setting is highly preferred • Previous Utilization Management experience is highly preferred • BSN is preferred • Graduate from Specialty Training Program-Nursing (Required) • Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania

🏖️ Benefits

• healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners • encourages an atmosphere of collaboration, cooperation and collegiality.