St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Clinical Triage Specialist (CTS) (RN) - Access Center will compassionately deliver an exceptional patient experience and provide clinical support to CTS-MA team members by serving as a clinical resource. The CTS-RN is responsible for using nursing judgment in answering/returning patient calls related to direct care provided by the practices. When appropriate, the caller’s symptoms will be assessed and triaged using approved nursing protocols and guidelines to assist in obtaining the appropriate level of care and/or self-care advice. JOB DUTIES AND RESPONSIBILITIES: Answers telephones, prioritizes clinical triage calls, follows clinical protocols, and coordinates services, as needed. Verifies patient demographic information and accurately enters the updated information into electronic health record. Serves as an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. Manages and responds to escalated electronic patient messages whenever not answering inbound patient calls and uses clinical judgment to prioritize and accommodate patients. Creates a positive patient experience at every encounter, attempting to independently resolve any issues or concerns of the patient at the time of the phone call, within the scope of the role. Consistently meets productivity, schedule adherence, and quality standards as set by the Access Center. Utilizes all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule appointments, or refer calls when necessary to the appropriate medical facility or personnel. Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. Partners with other Access Center teams/PODs and respective practice clinical team on behalf of the patient to assist with clinical concerns, medication refills, or scheduling appointments. Other duties as assigned. EDUCATION: Graduate of an accredited nursing program. Active Registered Nurse licensure in the state of Pennsylvania and New Jersey or other nursing compact state and other states as deemed necessary by state law. TRAINING AND EXPERIENCE: Minimum 2 years recent clinical experience in a physician office, home health, critical care and/or emergency room is required. Strong communication skills Focused on compliance Demonstrates continuous growth Quality-driven Service-oriented Excels at time management Strong problem-solving skills Ability to work from home in accordance with the Network Work from Home Policy if needed. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Clinical Triage Specialist (CTS) (RN) - Access Center will compassionately deliver an exceptional patient experience and provide clinical support to CTS-MA team members by serving as a clinical resource. The CTS-RN is responsible for using nursing judgment in answering/returning patient calls related to direct care provided by the practices. When appropriate, the caller’s symptoms will be assessed and triaged using approved nursing protocols and guidelines to assist in obtaining the appropriate level of care and/or self-care advice. JOB DUTIES AND RESPONSIBILITIES: Answers telephones, prioritizes clinical triage calls, follows clinical protocols, and coordinates services, as needed. Verifies patient demographic information and accurately enters the updated information into electronic health record. Serves as an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. Manages and responds to escalated electronic patient messages whenever not answering inbound patient calls and uses clinical judgment to prioritize and accommodate patients. Creates a positive patient experience at every encounter, attempting to independently resolve any issues or concerns of the patient at the time of the phone call, within the scope of the role. Consistently meets productivity, schedule adherence, and quality standards as set by the Access Center. Utilizes all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule appointments, or refer calls when necessary to the appropriate medical facility or personnel. Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. Partners with other Access Center teams/PODs and respective practice clinical team on behalf of the patient to assist with clinical concerns, medication refills, or scheduling appointments. Other duties as assigned. EDUCATION: Graduate of an accredited nursing program. Active Registered Nurse licensure in the state of Pennsylvania and New Jersey or other nursing compact state and other states as deemed necessary by state law. TRAINING AND EXPERIENCE: Minimum 2 years recent clinical experience in a physician office, home health, critical care and/or emergency room is required. Strong communication skills Focused on compliance Demonstrates continuous growth Quality-driven Service-oriented Excels at time management Strong problem-solving skills Ability to work from home in accordance with the Network Work from Home Policy if needed. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Clinical Triage Specialist (CTS) (RN) - Access Center will compassionately deliver an exceptional patient experience and provide clinical support to CTS-MA team members by serving as a clinical resource. The CTS-RN is responsible for using nursing judgment in answering/returning patient calls related to direct care provided by the practices. When appropriate, the caller’s symptoms will be assessed and triaged using approved nursing protocols and guidelines to assist in obtaining the appropriate level of care and/or self-care advice. JOB DUTIES AND RESPONSIBILITIES: Answers telephones, prioritizes clinical triage calls, follows clinical protocols, and coordinates services, as needed. Verifies patient demographic information and accurately enters the updated information into electronic health record. Serves as an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. Manages and responds to escalated electronic patient messages whenever not answering inbound patient calls and uses clinical judgment to prioritize and accommodate patients. Creates a positive patient experience at every encounter, attempting to independently resolve any issues or concerns of the patient at the time of the phone call, within the scope of the role. Consistently meets productivity, schedule adherence, and quality standards as set by the Access Center. Utilizes all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule appointments, or refer calls when necessary to the appropriate medical facility or personnel. Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. Partners with other Access Center teams/PODs and respective practice clinical team on behalf of the patient to assist with clinical concerns, medication refills, or scheduling appointments. Other duties as assigned. EDUCATION: Graduate of an accredited nursing program. Active Registered Nurse licensure in the state of Pennsylvania and New Jersey or other nursing compact state and other states as deemed necessary by state law. TRAINING AND EXPERIENCE: Minimum 2 years recent clinical experience in a physician office, home health, critical care and/or emergency room is required. Strong communication skills Focused on compliance Demonstrates continuous growth Quality-driven Service-oriented Excels at time management Strong problem-solving skills Ability to work from home in accordance with the Network Work from Home Policy if needed. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Registered Nurse (RN) Ambulatory delivers nursing care for patients across their life span, and through the nursing process, assesses, plans, implements, and documents the effects of care. Works cooperatively with ancillary, nursing and other patient-team personnel to maintain standards for professional nursing practice. These nursing functions of the RN are carried out according to the Pennsylvania Nurse Practice Act, hospital policy, the hospital Mission Statement, and the Philosophy of the Department of Nursing. JOB DUTIES AND RESPONSIBILITIES: Performs in depth, systematic assessment of all assigned patients. Formulates collaborative and individualized plan of care and identifies expected patient outcomes, using the nursing process. Implements, evaluates and documents patient care interventions and effectiveness in accordance with care plan. Organizes, coordinates and prioritizes patient care consistently utilizing available resources. Maintains an awareness of unit budget. Functions as a professional role model and resource person providing guidance to co-workers. Takes active role in unit-based performance improvement. Maintains responsibility for own professional development through active participation in in-services and/or continuing education programs. Complies with established chain of command for work related problems. Participates in identifying unit needs and supports unit goals and objectives that contribute to the growth of the Patient Services Department. Maintains departmental records for administrative and regulatory purposes. Collaborates with other caregivers to assure appropriate staffing levels on all shifts. PHYSICAL AND SENSORY REQUIREMENTS: Sit up to 2 hours per day; 1 hour at a time. Stand for up to 10 hours per day; 8 hours at a time. Walk 6 hours per day; 10 minutes at a time. Consistently lift, carry and push objects up to 10 lbs. Occasionally lift, carry and push objects up to 75 lbs. Transports patients weighing up to 500 lbs. via wheelchair, bed and/or stretcher. Frequently stoop and bend. Frequently reach above should level. Must be able to perceive attributes of an object through touch. Must be able to hear as it relates to normal conversation and high and low frequencies. Must be able to see as it relates to general, near, far, color and peripheral vision. EDUCATION: Current RN license in the State of Pennsylvania. TRAINING AND EXPERIENCE: One year medical/surgical experience preferred. Individualized orientation program for all areas. Evidence of successful completion of BLS. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The RN DRG Downgrades Appeals Review Specialist is responsible for the retrospective clinical review and defense of inpatient DRG downgrades, clinical validation denials, and medical necessity determinations issued by governmental and commercial payers. JOB DUTIES AND RESPONSIBILITIES: Conduct retrospective clinical record reviews to evaluate DRG downgrades, clinical validation denials, and medical necessity determinations. Analyze documentation in conjunction with MS-DRG logic and ICD-10-CM/PCS coding guidelines to determine appeal opportunity. Develop and submit defensible first- and second-level appeal letters using clinical evidence, regulatory guidance, coding standards, and payer policy. Collaborate with Physician Advisors, Coding leadership, and CDI to support higher-level appeals (e.g., IRO, ALJ, payer conferences). Identify denial trends and provide structured feedback to Coding and CDI leadership to reduce future payer vulnerability. Participate in payer audit response processes (RAC, QIO, MIC, commercial auditors) and assist in preparation for formal appeal proceedings. Maintain accurate documentation within EPIC, payer audit platforms, and internal tracking tools to support reporting and performance monitoring. Review denial data and appeal outcomes to assist leadership in assessing revenue impact, case resolution trends, and operational improvement opportunities. Maintain current knowledge of MS-DRG methodology, ICD-10-CM/PCS coding guidelines, clinical validation standards, federal and commercial payer policies, and medical necessity criteria. Serve as a clinical resource regarding documentation specificity and disease process validation as it relates to reimbursement defense. PHYSICAL AND SENSORY REQUIREMENTS: Sitting, standing and light lifting. Repetitive arm/finger use retrieving/viewing computerized patient medical record and abstracting of patient information. Corrected vision and hearing to within normal range. Hearing as it relates to normal conversation. Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required. BSN preferred. Active RN license required. CDI certification (CDIP, CCDS) preferred. TRAINING AND EXPERIENCE: Minimum five (5) years RN experience in adult inpatient acute care (medical/surgical or critical care). Strongly preferred: Clinical Documentation Improvement (CDI) experience. Strongly preferred: DRG downgrade or clinical validation denial experience. Strongly preferred: Utilization review or payer medical review experience. Familiarity with MS-DRG reimbursement methodology. Demonstrated understanding of disease pathophysiology and documentation specificity requirements. Working knowledge of ICD-10-CM/PCS fundamentals. Understanding of payer audit and appeal processes. Experience with EPIC and encoder tools (e.g., 3M) preferred. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
