Denials Management RN
About The Position
The Denials Management RN provides expertise in revenue cycle optimization by analyzing denied claims, identifying root causes, appealing rejections, and collaborating with departments to implement corrective actions and improve future claim submissions. The role also coordinates multidisciplinary care plans, assesses and coordinates care for a select patient population, and works to promote optimal clinical, quality, and cost-effective outcomes. The RN evaluates options and services to meet individual health needs, supports patient and family self-management, and collaborates with healthcare teams and health insurance payers across care settings to optimize clinical and financial outcomes.
Requirements
- Graduation from an accredited school of nursing.
- Three years of recent clinical work experience in the specialty area or a related clinical specialty in a hospital setting within the past five years, demonstrating requisite job knowledge, skills, and abilities.
- Registered Nurse: Washington, upon hire.
Nice To Haves
- Experience with utilization management, discharge planning, and/or case management.
- Accredited Case Manager certification, upon hire.
- Case Management Nurse certification, upon hire.
- Certified Case Manager certification, upon hire.
- Psychiatric and Mental Health Nurse certification, upon hire.
Responsibilities
- Analyze denied claims, identify root causes, and appeal rejections.
- Collaborate with departments to implement corrective actions and improve future claims submission processes.
- Coordinate multidisciplinary plans of care to promote optimal clinical, quality, and cost-effective outcomes.
- Collaborate with physicians and multidisciplinary teams to identify appropriate patients for care management review using established criteria.
- Assess, plan, and coordinate care for a select patient population.
- Evaluate available options and services to meet individual health needs and care team recommendations.
- Promote patient self-management and empower patients and families to achieve wellness and independence.
- Collaborate with healthcare team members across hospitals, clinics, residential care facilities, other settings, and health insurance payers to facilitate care and optimize clinical and financial outcomes.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
