RN ACCESS-PRE-CERT

Job Description

• POSITION SUMMARY
  
  • 
    The Pre-Cert RN Access facilitates effective utilization of appropriate health services via collaboration with physicians, nurses, social workers, other healthcare team members, and payers to coordinate health care services that optimize clinical outcomes and patient satisfaction prior to admission. This position performs pre-admission and clinical review of medical necessity to determine the appropriate level of care and resource utilization. The RN Access is responsible for ensuring implementation and monitoring of compliant documentation strategies by ensuring orders are present, accurate and signed prior to patient being admitted.
    
    
• MINIMUM QUALIFICATIONS AND REQUIREMENTS
  
  • Licenses and Certifications Required
    
    • Current or temporary RN license in ND or compact RN licensure
      
    • Certification in Case Management is preferred
      
    • BLS certification preferred
      
  • Educational Requirements
    
    • BSN strongly preferred
      
  • Experience Requirements
    
    • Three (3) years of recent clinical experience in an acute care or ETC setting preferred
      
    • Prior Case Management/Utilization Review experience preferred
      
  • Special Skills or Training Requirements
    
    • Demonstrated evidence of dependability, diplomacy, and initiative
      
    • Demonstrated strong communication and interpersonal skills with all levels of internal and external customers, including but not limited to medical staff, clinical personnel, Case Managers, support and technical staff, outside agencies, third party payers, and members of the community
      
    • Basic understanding of reimbursement issues, denials, and DRGs
      
    • Personal computer skills using e-mail, word processing, accessing payer websites, etc.
      
    • Knowledge of clinical criteria for medical necessity
      
    • Ability to multi-task in high volume work environment
      
    • Ability to prioritize the workload depending on the needs of the patient