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RN Denials Manager Full Time Days | Registered Nurse in Nurse & Healthcare Job in Annapolis MD1

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RN Denials Manager Full Time Days

Annapolis, MD

Job Functions: Nursing - Clinic RN - sition Objective: Responsible for managing denials by from time of notification of denial through appeal process facilitating peer to peers and denial letter response. Works closely with the physician advisor to reduce clinical denials by decreasing clinical variation. Monitors clinical denial write-offs vs budget as well as coordinating the next fiscal years* clinical denial budget targets. Essential Position qualifications: Reasonable accommodations may be made to enable individuals with disabilities to perform the key functions. Completes denial process for denied days for medical necessity utilizing designated criteria set. Completes evaluation of all external denials for medical necessity received by the hospital and facilitates appeals to closure with the goal to mitigate any denials. Performs analysis on clinical denials and tracks denials and appeal results, and coordinates info with PFS, Care Management and the UM Committee Is versed and proficient in internal IT tools (DataBay, etc) and performs analysis and trending of clinical denials. Utilizes trended data create prevention strategies to reduce/ eliminate denials. Participates in clinical education sessions for medical and clinical staff. Serves as the primary coordinator of clinical and administrative denials/clinical denial appear efforts etc, with outsourced legal support. Participating in regulatory audits (RAC, QIO). Partners with physician advisors in effecting permanent clinical denial mitigation. Identifies and escalates denial trends by payer, physician, denial reason Evaluates all clinical documentation supporting clinical denials and makes recommendations for EMR modifications to alleviate clinical and administrative denials. Educational/Background Qualifications: Required Min Education. The min level of education for this position includes: BSN Required Min Background: 5-7 yrs of related skills in UR, case management, and/or denial management. Proficient knowledge of regulatory qualifications. Required License/Certifications: Case Management certification preferred; certification in utilization management. Knowledge, Skills, Abilities: Strong verbal and writing skills. Working know of Microsoft word, Ms excel and EPIC required. Work conditions, Equipment, Physical qualifications: Light work. Exerting up to twenty pounds of force occasionally, and/or up to 10 lbs of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work. There is reasonable expectation that employees in this position will not be exposed to blood-borne pathogens. The above is intended to describe the general content of and qualifications for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or qualifications. See position overview
Graduate Degree
August 28 on LatPro
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More About this Listing: RN Denials Manager Full Time Days
RN Denials Manager Full Time Days is a Nurse & Healthcare Registered Nurse Job located in Annapolis MD. Find other listings like RN Denials Manager Full Time Days by searching Oodle for Nurse & Healthcare Registered Nurse Jobs.