RN Pre Certification Case Manager

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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?

Job Title: RN Pre Certification Case Manager

Department: Business Operations - PMC

Location: Penn Medicine University City- 3737 Market St

Hours: Day Shift M-F 7:30-4:00

**Competitive Benefits, Career Growth Opportunities and Tuition Assistance at University of Pennsylvania! **

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?

Summary:

• To ensure access to superior integrated health care, achieve clinically appropriate and financially sound resource utilization, support the insurance verification team, clinical staff and verify accuracy of financial and contractual requirements to assure optimal reimbursement for the hospital for services provided.

Responsibilities:

• Interact with medical staff and their designees to obtain complete, accurate and timely clinical and financial information required for payer reimbursement. Asses clinical information for appropriateness of settling and utilization of resources to optimize patient outcomes and cost effective. Provide required clinical and demographically information to payer to obtain pre-certification and assure reimbursement. Identify potential quality and utilization concerns and refer to the Director when appropriate. Follow up with action as indicated. Maintain communication with and provide education to all involved departments included but not limited to admissions, patient financial services, clinical resource management and provider medical staff and designees. Assist in preparation of complete, accurate and timely reports both for utilization and quality. Meet on a regular basis with the Director and communicate clearly the progress and status of all assigned functions. Identifies and implements opportunities for work redesign/cross training within the department Assures compliance with Federal/State regulation applications in registration EMTALA and Advance Directives as example. Ensures compliance with all JCAHO regulations.

Credentials:

• Registered Nurse - PA (Required)
• Pennsylvania State Licensed Nurse required.

Education or Equivalent Experience:

• Bachelor of Arts or Science (Required)
• Education Specialization: NursingEquivalent Experience:•And 5+ years Prior experience as a nurse case manager with knowledge of utilization review and third party payors.

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 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.