Seeking a Precertification Nurse Responsibilities/Required Skills/Experience The precert nurse utilizes clinicalskills to support comprehensive coordination of medical services including makinginitial coverage determinations, screening and referrals to Medical Services Programs.
More specifically, precertification is the process of collecting information prior
to inpatient admissions and performance of selected ambulatory procedures and services.
Precertification may either be done telephonically or electronically. There are
two components of Precertification: Notification and Medical Review. REQUIRED SKILLS:
-Practical Nurse (LPN) or LVN depending on state requirements, or Registered nurses
(RN) with current unrestricted Texas state licensure is required-(3-5) years recent
clinical experience in a hospital, inpatient rehabilitation, skilled nursing facility
or physician's office-Managed care or utilization management experience preferred
but not required -Must have proficient keyboarding skills and ability to navigate
through multiple computer systems-Requires excellent communication skills and ability
to multitask with an emphasis on quality and productivity-Requires advance eligibility
verification, determination of coverage, and communication with the physician and/or
member-Coordinates the patient's transition from the inpatient setting to the next
level of care (discharge planning), or to refer patients for specialized programs
such as Disease Management, Case Management.
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