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Jefferson Health

Academic health system

Clinical Research Nurse

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timePhiladelphia, PA, USANo salary listedIn-person

About the Job

Requirements

  • An Associate’s Degree in Nursing Diploma or an Associate’s Degree in Nursing is required.
  • A Bachelor’s Degree in Nursing is required.
  • A minimum of 1 year of RN clinical experience in a health care setting is required.
  • Three years of case management, discharge planning, or utilization management experience are required.
  • Knowledge of managed care, governmental payors, and third-party payor reimbursement is required.
  • Proficiency with InterQual and MCG criteria and their application is required.
  • Ability to prioritize workload, collaborate to meet multiple deadlines, communicate effectively orally and in writing, work in a team environment, and document in electronic health records is required.
  • Knowledge of medical, social, economic, and other services provided by departments or facilities, and ability to integrate multidisciplinary treatments for optimal patient care, is required.
  • Knowledge and understanding of legislation and regulatory bodies affecting healthcare practices is required.
  • Ability to work constructively and collaboratively with a variety of individuals and groups is required.
  • Ability to manage concurrent objectives, projects, groups, or activities and make effective judgments about priorities and time allocation is required.
  • Must hold a Pennsylvania state Registered Nurse license.
  • Must be able to lift and carry 40–50 pounds, including pushing or pulling patients on beds or stretchers and performing lateral transfers.
  • Frequent to continuous standing and walking is required; patient transport may involve walking 8–10 miles per shift.
  • Patient-care providers may be required to kneel, bend, squat, and perform CPR.
  • Must identify patients using appropriate patient identifiers.
  • Must use an interdisciplinary collaborative team approach to patient care planning and discharge coordination.
  • Must ensure patient medical information is properly communicated to external providers and facilities and transferred to them.
  • Must communicate the discharge plan to patients, families, and multidisciplinary team members.
  • Must understand how developmental stage affects adjustment to illness or trauma, including adolescent behaviors concerning body image, independence, sexual identity, identity development, and denial or minimization of illness severity.
  • Must support adult patients’ control and involve families in decision-making; consider physical, social, emotional, and physical-limitation barriers for geriatric patients; and demonstrate understanding of end-of-life issues.
  • Must assess and anticipate discharge-planning needs for a safe and effective transition to the next level of care, and involve the patient, family, or guardian in discharge-planning decisions.
  • Must communicate effectively with neonate, infant, adolescent, and geriatric patients.
  • Must recognize signs of physical or emotional abuse or neglect, follow reporting policies and procedures, and identify hearing and sight deficiencies in geriatric patients.

Responsibilities

  • Collect and document clinical information from study participants.
  • Provide patient education about research studies.
  • 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 minutes.
  • Refer cases to the Physician Advisor according to department procedures when further review or clarification is needed.
  • Apply relevant medical-necessity criteria to patients within 24 hours of admission to determine appropriate patient status.
  • Complete retrospective clinical reviews for cases requiring third-party payor medical-necessity approval for payment.
  • Document the appropriate medical-necessity criteria level-of-care guideline 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 IRO appeal.
  • Perform appeal processes in coordination with the formats and protocols of specific third-party payors.
  • Refer cases without documentation of 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 reviews.
  • 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.
  • Assess and anticipate discharge-planning needs and help ensure safe transitions to the next level of care.
  • Collect and process specimen tissue for analysis by technical personnel when needed.
  • Collaborate with the research team and participate in identifying, developing, implementing, and evaluating specific goals and objectives.
  • Support administration in adhering to protocol guidelines.
  • Collect and help organize data for the research team.

Desired Qualifications

  • A Bachelor of Science in Nursing (BSN) is preferred.
  • Less than 1 year of research experience is preferred.
  • Certification in InterQual criteria is preferred.

About the Company

Jefferson Health

Academic health system

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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