RN, Registered Nurse – Clinical Access Specialist, Per Diem

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

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Geisinger

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1915

🏥 Healthcare

💊 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

• Perform initial, concurrent and retrospective medical record reviews for medical necessity and level-of-care determination • Ensure adherence to state, federal and third-party payer certification requirements • Identify and notify appropriate staff about third-party payer health insurance coverage discrepancies and lack of coverage • Maintain knowledge of third-party payer health plans, nationally recognized review criteria, and state and federal regulations • Review cases and perform precertification requirements under third-party payer contracts • Review admission requests for level-of-care appropriateness and compliance with certification requirements and ambulatory procedures • Request additional clinical information and documentation when medical necessity criteria are not met • Provide information, suggest alternatives, and assist with documentation integrity • Enter utilization review data into databases for tracking, trending audits, billing, reimbursement and Medicare compliance • Report serious events and incidents according to hospital policy and procedure • Ensure integrity of medical-necessity chart reviews and application of review requirements • Act as a resource for the healthcare team regarding payer benefits and transitions to the next level of care or discharge home • Work variable hours during the week or weekend in a per diem role

🎯 Requirements

• Graduate from Specialty Training Program-Nursing (Required) • Minimum of 3 years of nursing experience (Required) • Licensed Registered Nurse in Pennsylvania (Required) • Acute care experience preferred • Utilization Management experience highly preferred • BSN preferred • Knowledge of third-party payer health plans • Knowledge and application of nationally recognized review criteria • Knowledge of state and federal regulations and mandates • Ability to perform medical necessity and level-of-care reviews • Ability to perform precertification reviews under payer contracts • Ability to use databases for utilization review tracking, audits, billing, reimbursement and Medicare compliance • Ability to work variable hours during weekdays or weekends • Must satisfy job-specific obligations and comply with organization policies and procedures

🏖️ 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 with a financial incentive • Adoption and fertility assistance • Parental leave pay • Military leave pay • Free Care.com membership with discounted backup care • Employee Assistance Program (EAP), including childcare, eldercare, pet care referrals, free legal guidance, mental health visits, work-life support, and digital self-help tools • Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life, pet and legal insurance • Healthcare benefits for full-time and part-time positions from day one, including vision, dental and domestic partner benefits • Collaborative, cooperative and collegial work atmosphere