Pre-Certification Nurse
Not Disclosed•Full-TimeOn-site
location_on99, North Main Street, Lauderdale Courts, Memphis, Shelby County, West Tennessee, Tennessee, 38107, United States
About the Role
The Precertification Nurse serves as a critical bridge between clinical care, insurance protocols, and patient advocacy. This role exists to ensure that referrals and precertifications are executed with precision, adhering to established protocols to facilitate seamless patient care pathways.
In this position, you will primarily focus on obtaining necessary precertifications for procedures and testing, while acting as a key communicator among patients, external medical offices, and internal staff regarding policies and guidelines. Your day-to-day involves conducting daily investigations to validate insurance eligibility and submitting pertinent clinical data—including ICD10, HCPCS, and DRG codes—to payers.
Beyond administrative duties, you will provide education and information to medical staff, patients, and families, ensuring a customer-responsive and courteous approach that aligns with iRESPECT Standards. You will also maintain accurate patient medical records, document care status, and utilize computer systems to generate statistics and reports. A significant part of your contribution involves supporting the organization's Performance Improvement initiatives, assisting in the development of care indicators, and responding to opportunities to improve care quality.
You will work within a clean, orderly, and safe environment, strictly adhering to infection control practices, risk management, and patient safety standards. Confidentiality of all patient information is paramount, maintained in full compliance with hospital policies, HIPAA, and other regulatory requirements.
Work location
Work model: On-site
99, North Main Street, Lauderdale Courts, Memphis, Shelby County, West Tennessee, Tennessee, 38107, United States
Memphis, Tennessee
Key Responsibilities
- check_circleConduct daily investigations to validate insurance eligibility
- check_circleMaintain patient medical records and document patient status using computer systems
- check_circlePrepare and maintain administrative and compliance records and reports
- check_circleVerify payer sources for patients requiring precertification for procedures or testing
- check_circleSupport performance improvement initiatives and contribute to unit scope reviews
- check_circleProvide education to medical staff, patients, and families regarding policies and guidelines
- check_circleCollaborate with patients, families, and hospital staff to ensure customer satisfaction
- check_circleEnsure adherence to infection control, safety, and HIPAA compliance standards
- check_circleSubmit clinical data including ICD10, HCPCS, and DRG codes to payers
Requirements
- verifiedGraduate of an approved nursing school/program
- verifiedMinimum 3 years experience
- verifiedPre-certification experience
- verifiedAt least 1 year Liaison & marketing experience
Nice to Have
Liaison & marketing experience
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Skills, education and keywords
Skills: Icd10, HCPCS, DRG, Hipaa, Pre-Certification.
Education: Graduate of an approved nursing school/program required.
Frequently asked questions about Pre-Certification Nurse at Regional One Health
What does a Pre-Certification Nurse at Regional One Health do?expand_more
A Pre-Certification Nurse at Regional One Health is responsible for the following: Conduct daily investigations to validate insurance eligibility; Maintain patient medical records and document patient status using computer systems; Prepare and maintain administrative and compliance records and reports; and Verify payer sources for patients requiring precertification for procedures or testing.
What are the requirements for this Pre-Certification Nurse role?expand_more
To qualify for the Pre-Certification Nurse at Regional One Health position, applicants should have: Graduate of an approved nursing school/program; Minimum 3 years experience; Pre-certification experience; and At least 1 year Liaison & marketing experience.
Where is the Pre-Certification Nurse role at Regional One Health located?expand_more
Pre-Certification Nurse at Regional One Health is based in 99, North Main Street, Lauderdale Courts, Memphis, Shelby County, West Tennessee, Tennessee, 38107, United States. This is a on-site role.
Is this Pre-Certification Nurse job remote, hybrid, or on-site?expand_more
Regional One Health has listed this Pre-Certification Nurse role as on-site.
How much experience is required for this Pre-Certification Nurse role?expand_more
Pre-Certification Nurse at Regional One Health typically requires 3+ years of relevant experience at the mid level level.
What skills do you need for the Pre-Certification Nurse role at Regional One Health?expand_more
Key skills for Pre-Certification Nurse at Regional One Health include Icd10; HCPCS; DRG; Hipaa; and Pre-Certification.
What education is required for Pre-Certification Nurse at Regional One Health?expand_more
Educational requirements for this role: Graduate of an approved nursing school/program required.
What category does the Pre-Certification Nurse role belong to?expand_more
Pre-Certification Nurse at Regional One Health is part of the healthcare & nursing job category on Recrutus.
About Regional One Health
Regional One Health, based in Memphis, Tennessee, operates as a comprehensive healthcare system dedicated to delivering accessible, efficient, and high-quality care across the Mid-South. Serving primary regions of west Tennessee, east Arkansas, and north Mississippi, the organization focuses on inpatient, surgical, and specialty care through its affiliated medical centers.
As a key training ground for medical professionals, Regional One Health partners with the University of Tennessee Health Science Center at Memphis to support medical education. Over 50% of Tennessee’s healthcare providers have completed training at the system, reinforcing its role in advancing regional medical expertise. The system includes Centers of Excellence in trauma, burn care, neonatal intensive care, and high-risk obstetrics at its flagship Regional Medical Center.
The health system also offers primary care services and an outpatient care center featuring more than 38 specialty areas. By combining clinical excellence with educational partnerships, Regional One Health addresses diverse healthcare needs while fostering professional development in the Mid-South.
Browse more roles: All Regional One Health jobs, healthcare & nursing jobs on Recrutus.