Description

Is responsible for obtaining treatment plans and diagnoses to secure third party authorization for hospital admissions, tests, treatments, and procedures for transplant patients. Ensures compliance with all HIPPA and appropriate regulatory guidelines.

Responsibilities:

• Acts as a resource and provides support to coordinator staff in obtaining authorizations to facilitate patient care.
• Serves on departmental or interdisciplinary committees as requested.
• Maintains medical records in accordance with hospital and department policies and standards.
• Participates in activities that enhance professional development including conferences and continuing education programs.
• Demonstrates on a consistent basis the behaviors that comprise The Basics of Service Excellence.
• Conveys treatment plan to third party payors.
• Provides verbal and/or written clinical information as required to insurers/regulatory agencies in order to obtain authorizations. Documents all necessary information related to authorizations.
• Acts as a liaison between physician office and insurance companies to ensure payment for prescribed medications, procedures, treatments and hospital admissions.
• Acts as a resource to staff regarding third party payor regulations and processes as they relate to coverage and reimbursement.

Qualifications

• Diploma or Associates Degree in Nursing 
• Demonstrated competence in professional nursing practice  
• 2 years recent clinical experience 
• Ability to obtain and interpret information in terms of specific needs for authorization process  
• Understanding of range of treatments needed by transplant patient population 
• Familiarity with various third party payors and implications of managed care  
• Pre-authorization/utilization review experience desirable 
• Transplantation experience desirable 
• Excellent communication skills  
• High level of organizational skill and ability to manage multiple tasks concurrently

Licensure, Certifications, and Clearances:

• Act 34 Criminal Clearance
• Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

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