Job ID: 161657
Work Type: FT
Location: Philadelphia, PA, United States
Date Posted: Nov 18, 2022
DescriptionPenn 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.
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.
BSN in Nursing required
3 years or more in case management or third party payer experience
PA RN license