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Precertification Coordinator

Job ID: 161657
Category: Nursing
Work Type: FT
Location: Philadelphia, PA, United States
Date Posted: Nov 18, 2022

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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

The lead precertification nurse is responsible for coordinating the timely movement of high acuity urgent / emergent patients into the University of Pennsylvania Health System. As a seasoned professional, the precert RN consults with the physician staff regarding patient care issues and concerns and advises the team as appropriate. Working collaboratively with the transfer center staff, business office, on call physicians, and the referring facility, the precert RN facilitates appropriate and timely patient transfers into UPHS facilities. The precert RN is responsible for securing authorization from the payer prior to patient transfer thereby ensuring facility reimbursement is approved.

The lead nurse case manager precert nurse:

· Oversees day to day operations and staffing for UPHS hospitals.

· Applies nursing knowledge derived from education and experience as a foundation for gathering appropriate clinical data to ensure appropriate placement, communication and documentation for all patient transfers.

· Ensures EMTALA proficiency and implementation for all patient transfers meeting criteria.

· Establishes and maintains a high degree of awareness and knowledge of UPHS contracts, facility specialties, medical staff, services and clinical protocols.

· Communicates with providers and referring facilities if transfer of a specific patient may be problematic; utilizes problem solving skills to determine the best course of action, which will be satisfactory to all parties involved.

· Participates in data collection, monitoring, evaluation, and analyzing of transfer problems for the purpose of developing and implementing protocols, policies and procedures. Provides month end reports for the leadership team.

    · 24/7 accountability for all patient precertification through the UPHS transfer center.

    Qualifications:

    BSN in Nursing required

    3 years or more in case management or third party payer experience

    PA RN license 

      We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

      Live Your Life's Work

      We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

         Current UPHS employees must apply HERE
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