Job Description

Pre-Access Clinical Specialist-Full Time-Nebraska Methodist Health

Nebraska Methodist Health System is seeking a dedicated full- time Pre-Access Clinical Specialist committed to ensuring accurate insurance verification, pre-authorization, and medical necessity for high-quality patient care and operational excellence.

Job Duties & Responsibilities:

• Manages complex pre-access workflows by verifying eligibility, securing medical necessity checks, obtaining pre-authorizations, and creating accurate cost estimates in the EMR.
• Ensures accurate communication and documentation with provider offices, patients, and internal teams regarding authorization status, outcomes, and payer requirements.
• Serves as a clinical resource and mentor , offering guidance, training, and support to fellow Pre-Access team members while promoting collaboration and shared goals.
• Adapts to evolving processes and maintains up-to-date reference materials to ensure accuracy, consistency, and compliance in all pre-service procedures.
• Demonstrates accountability and initiative by recognizing issues, taking appropriate action, and participating in quality assurance efforts to meet departmental standards.

Location:

• Methodist Corporate Offices-825 S 169th St. - Omaha, NE

Schedule:

• Mon - Fri, 8:00am to 4:30pm

Job Requirements:

• Graduate of an accredited nursing program required.
• Bachelor of Nursing (BSN) preferred.

Experience:

• Minimum 3-5 years clinical experience required.
• Previous experience in utilization review, precertification, or case management is preferred.

License/Certifications:

• N/A

About Methodist:

Methodist Health System named by Forbes in 2024 as "Nebraska's Best Employer" and "Best Employer for New Graduates"

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.

Job Tags

Similar Jobs