Clinical Appeals Specialist (RN)
Care New England Health System - Finance Job ID: 08244-80805-001
40 hours per week.
Weekend & Holiday Shift
THIS POSITION WILL OPERATE UNDER THE REVENUE INTEGRITY DEPARTMENT. Responsible for managing clinical denials and appeals including identifying opportunities to improve payer and provider process improvements to improve cash flow. No weekend and no holidays.
Bachelor’s degree in nursing with a minimum of five years acute care experience. Working knowledge of level of care criteria and knowledge of state and federal regulations is required. Three years or more of relevant recent case management and/or administrative experience in medical/surgical nursing; two years of which must be related to utilization review activities, demonstrating organizational skills and ability to make sound clinical judgments. Excellent oral and written skills and knowledge and ability to collaborate with clinical, operational and financial areas required.