Denials Management RN

CommonSpirit Health • Bremerton, WA

10h

About The Position

The Denials Management RN provides expertise in revenue cycle optimization by analyzing denied claims, identifying root causes, appealing rejections, and collaborating across departments to implement corrective actions and improve future claims submissions. The role supports revenue integrity and financial stability through persistent, detail-oriented work and effective communication.

The position also facilitates multidisciplinary care planning to promote optimal clinical, quality, and cost-effective outcomes. It collaborates with physicians and multidisciplinary teams to identify appropriate patients for care management review using established criteria; assesses, plans, and coordinates care for a select patient population; and evaluates options and services to address individual health needs and care team recommendations. The role promotes patient self-management and supports patients and families in achieving wellness and independence. It works with healthcare teams across hospitals, clinics, residential care facilities, other settings, and health insurance payers to coordinate care across the continuum and 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 the required 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; or Case Management Nurse certification, upon hire; or Certified Case Manager certification, upon hire; or Psychiatric and Mental Health Nurse certification, upon hire.

Responsibilities

• Analyze denied claims, identify root causes, appeal rejections, and collaborate with departments to implement corrective actions and improve future claims submissions.
• Facilitate coordination of multidisciplinary care plans to promote optimal clinical, quality, and cost-effective outcomes.
• Collaborate with physicians and multidisciplinary teams to identify patients appropriate 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 and health insurance payers to coordinate care across the continuum and optimize clinical and financial outcomes.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level