Pre-Certification - Registered Nurse

Join a team that delivers excellence.

Lehigh Valley Health Network (LVHN) is home to nearly 23,000 colleagues who make up our talented, vibrant and diverse workforce.

Join our team and experience firsthand what it's like to be part of a health care organization that's nationally recognized, forward-thinking and offers plenty of opportunity to do great work.

Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region.

Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety.

These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

Screens inpatient and ambulatory reservations to ensure that insurance approval has been obtained and the patient is scheduled for the appropriate level of care.

Calls physician offices to verify / obtain additional clinical information and insurance authorizations / referrals. Obtains insurance verification and precertification for approval.

Job Duties

• Communicates with other hospital departments, physician offices, and insurance companies to ensure hospital compliance with medical necessity and pre-certification requirements.
• Keeps informed of regulatory requirements and changes concerning medical, medical assistance, and other third-party payors.
• Maintains updated precertification information and distributes to pre-cert team and appropriate departments.
• Screens inpatient and ambulatory reservations to determine level of care and obtains insurance approval.
• Refers questionable situations to the manager and / or director of pre-certification as needed. Seeks out the physician advisor for review and / or action involving rescheduling or cancellation of services.

Minimum Qualifications

• Bachelor's Degree in nursing, healthcare administration or healthcare related field.
• 5 years of experience in pre-certification and utilization management review.
• Must be adept at using various computerized insurance verification systems.
• Must be knowledgeable in health insurance requirement.
• Must have good assessment skills to make appropriate referrals.
• Must be self-directed and able to prioritize duties within a rapidly changing environment.
• Must be knowledgeable in health insurance requirements.
• RN - Licensed Registered Nurse PA - State of Pennsylvania Upon Hire

Physical Demands

Lift and carry 25 lbs. frequent sitting / standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer : This position description provides the major duties / responsibilities, requirements and working conditions for the position.

It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs.

Other responsibilities may be assigned when circumstances require.

Influenza vaccination and COVID-19 Vaccination is required for all colleagues unless medically contraindicated or due to a bona fide religious belief or practice.

Applicants possessing a medical marijuana card will not be considered for safety sensitive positions.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law.

All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and / or social activities.