Pre-certification - Registered Nurse

Lehigh Valley Health Network

Remote, Pennsylvania, US
Fully remote
5 years pre-certification experience
3 years nursing field experience
Knowledge of health insurance requirements
Lehigh Valley Health Network is seeking a fully remote Registered Nurse for their Pre-certification team. This role focuses on obtaining insurance approvals and ensuring compliance with medical necessity requirements

Job Summary

  • The role involves screening inpatient and ambulatory reservations to ensure insurance approval and appropriate level of care scheduling.
  • Candidates must communicate with hospital departments, physician offices, and insurance companies to maintain compliance with medical necessity and pre-certification requirements.
  • Lehigh Valley Health Network is a Magnet Hospital recognized for nursing excellence and patient safety across multiple locations.

Matching Summary

Match Score: 85

Lehigh Valley Health Network is seeking a fully remote Registered Nurse for their Pre-certification team. This role focuses on obtaining insurance approvals and ensuring compliance with medical necessity requirements.

Skills & Requirements

Must-have

  • 5 years pre-certification experience
  • 3 years nursing field experience
  • Knowledge of health insurance requirements
  • Computerized insurance verification systems
  • Medical necessity compliance assessment

Nice-to-have

  • Self-directed prioritization skills
  • Ability to work in rapidly changing environment
  • Strong communication with physician offices
  • Teamwork and compassion focus

Key Requirements

  • Associate's Degree in nursing or healthcare field
  • Licensed Registered Nurse in Pennsylvania
  • 5 years experience in pre-certification and utilization management
  • 3 years experience in the nursing field

Work Rights

Must be licensed RN in Pennsylvania

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