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Jefferson Health

Academic health system

Clinical Research Nurse

Full-TimeUpdated on 10/5/2026
No salary listed
Mid
Bachelor's, Associate's
Philadelphia, PA, USA
In Person

About the job

Requirements
  • An Associate’s Degree in Nursing or a Bachelor’s Degree in Nursing.
  • At least 1 year of registered nurse clinical experience in a health care setting.
  • At least 3 years of case management, discharge planning, or utilization management experience.
  • Knowledge of managed care, governmental and third-party payer reimbursement.
  • Proficiency with InterQual and MCG criteria and their application.
  • Ability to prioritize workload, collaborate to meet multiple deadlines, communicate orally and in writing, work in a team environment, and document in electronic health records.
  • Knowledge of medical, social, economic, and other services provided by other departments or facilities, and ability to integrate multidisciplinary treatments for optimal patient care.
  • Knowledge and understanding of legislation and regulatory bodies affecting health care practices.
  • Knowledge of techniques for working constructively and collaboratively with varied individuals and groups.
  • Ability to manage multiple concurrent objectives, projects, groups, or activities and make effective prioritization and time-allocation judgments.
  • Registered Nurse license in Pennsylvania.
  • Ability to lift and carry 40–50 pounds; push or pull patients on beds or stretchers; perform lateral transfers; stand and walk frequently to continuously; and, as applicable to the role, kneel, bend, squat, and perform CPR.
Responsibilities
  • Collect and document clinical information from study participants.
  • Provide patients with education about the research study.
  • Obtain informed consent and support enrollment into clinical trials.
  • Interact with consortium members, organize meetings, communicate with participating institutions, track and record progress, schedule meetings, and record and distribute meeting minutes.
  • Collect and process tissue specimens for technical analysis, as needed.
  • Collaborate with the research team and participate in identifying, developing, implementing, and evaluating specific goals and objectives.
  • Support administration in adherence to protocol guidelines.
  • Collect and help organize data for the research team.
  • Refer cases to the Physician Advisor when departmental procedures require further review or clarification.
  • Apply relevant medical necessity criteria to all patients within 24 hours of admission to determine appropriate patient status.
  • Complete retrospective clinical reviews for cases requiring third-party payer medical necessity approval for payment.
  • Document the appropriate medical necessity criteria level-of-care guidelines subset.
  • Evaluate Level I medical necessity appeal results to determine whether a Level II appeal is appropriate, and refer cases to the Physician Advisor for input as needed.
  • Evaluate contract auditor retrospective denials for appropriateness of appeal.
  • Follow departmental procedures for Condition 44 downgrades, including medical record documentation and informing the patient and Case Manager.
  • Perform the appeal process and procedures for cases identified for Independent Review Organization appeal.
  • Perform appeal processes in accordance with specific third-party payer formats and protocols.
  • Refer cases without documentation supporting acute level of care to the Physician Advisor.
  • Research clinical aspects of cases as necessary to provide information for appeals.
  • Track and maintain a list of Medicare admissions requiring review.
  • Document in patient medical records and work queues according to departmental policies and procedures.
  • Identify consistent issues related to denial and appeal activities and report them to the Manager.
  • Adhere to organizational policies and procedures, third-party payer contract utilization management workflows, and governmental payer processes.
  • Use appropriate patient identifiers and an interdisciplinary collaborative team approach to patient care planning and discharge coordination.
  • Ensure patient medical information is properly communicated to external providers and facilities, and communicate discharge plans to patients, families, and multidisciplinary team members.
  • Understand how developmental stages affect adjustment to illness or trauma, including adolescent concerns about body image, independence, sexual identity, and establishing identity; support adult patient control and family involvement in decisions; consider physical, social, and emotional barriers and limitations affecting geriatric patients; and understand end-of-life issues.
  • Assess and anticipate discharge-planning needs to support a safe and effective transition to the next level of care, involving the patient, family, or guardian in discharge decisions.
  • Communicate effectively with neonate, infant, adolescent, and geriatric patients.
  • Recognize signs of physical or emotional abuse or neglect and follow applicable reporting policies and procedures.
  • Identify hearing and sight deficiencies in the geriatric population.
  • Ensure patient information is transferred to external providers and facilities.
Desired Qualifications
  • Less than 1 year of research experience.
  • Certification in InterQual criteria.

About the company

Jefferson Health is an academic health system serving Philadelphia, South Jersey, and surrounding communities. The system delivers hospital, specialty, primary, emergency, outpatient, research, and professional education services across its care network. It serves patients, families, clinicians, students, researchers, and regional communities. Its operating model centers on clinical care integrated with university education, research, physician practices, and shared health-system operations. Teams work across nursing, physicians, allied health, research, education, technology, facilities, administration, and patient access. This structure supports consistent delivery across the organization.

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