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Clinical Appeals Specialist (RN)

Care New England Health System - Finance Job ID: 08244-80805-001

Status
Full-Time
Hours
40 hours per week.
Shift
Day
Weekend & Holiday Shift
N/A
Has Benefits
Yes
Job Description
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.
Required Education
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.
Application Method
Apply Online

It is the policy of CNE to provide equal employment opportunities to all qualified employees and applicants for employment without regard to their race, color, religion, gender, sexual orientation, gender identity or expression, age, national origin, genetic information, veterans status or disability.