Clinical Appeals RN (Infusion Denials)

BJC HealthCare • St. Louis, MO

6d • Remote

About The Position

Join our team as a Clinical Appeals RN and advocate for patients in a unique way! As a remote nurse, you'll be part of an interdisciplinary team that appeals denials on behalf of each patient you support. With clinical appeals to insurance companies, you can increase patient satisfaction even after a denial has been made. This position supports the Outpatient Infusion Centers.

Requirements

• RN
• 2-5 years experience
• At least 1 year of Utilization Review, Case Management, and/or Clinical Appeals experience
• Nursing Diploma/Associate's - Nursing

Nice To Haves

• At least 2-3 years of hospital-based RN experience
• BSN
• Prior experience with EPIC
• Bachelor's Degree - Nursing

Responsibilities

• Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care.
• Uses Interqual Criteria to determine level of care for all elective inpatient hospitalizations to assure services are provided in the appropriate setting.
• Ensure that the administration of hospital resources are appropriate, efficient and fall within the parameters of the patient's payment structure while providing safe and quality care.
• Evaluate the cost and quality of medical services provided by the medical team.
• Ensure appropriate utilization, which includes the evaluation of potential under and over-utilization according to patient's presentation and documentation.
• Education of medical providers and other health care professionals on the appropriate and cost-effective use of health care resources.

Benefits

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree