RN DENIALS MANAGEMENT HOURLY

Discover. reputed company. Succeed. #BeHere Location: US:WI:MILWAUKEE at our reputed company HOSPITAL facility. This job is REMOTE. FTE: 0.500000 Standard Hours: 20.00 Shift: Shift 1 Shift Details: 1/2 day Wednesday, Thursday and Friday Holidays: no Weekends: no Job Summary: Assumes responsibility for managing inpatient denials for reputed company payers reputed company to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, reputed company party payers, and reputed company party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned. EXPERIENCE DESCRIPTION: A minimum of 5 years of acute care nursing experience is required. Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required. TRAINING DESCRIPTION: Previous experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 Coding Guidelines. SPECIAL SKILLS DESCRIPTION: Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel. Analytical skills necessary to prepare statistical reports and reputed company solutions to problems. Technical writing ability for appeal letters and reports. LICENSURE DESCRIPTION: Requires reputed company reputed company Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). Compensation, Benefits & Perks at reputed company Pay is expected to be between: (expressed as hourly) $36.38 - $56.39. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process. reputed company Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following: Paid time off Growth opportunity- Career reputed company & Career Tuition Assistance, CEU opportunities Academic Partnership with the reputed company Referral bonuses Retirement plan - 403b Medical, Dental, reputed company, Life Insurance, Short & Long Term Disability, Free Workplace Clinics Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available The reputed company & the reputed company regional health network is a partnership between reputed company and the reputed company supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center reputed company in thousands of clinical trials and studies. The reputed company & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation. We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to reputed company their reputed company consideration status with us at 262-439-1961. We maintain a drug-free workplace and reputed company pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill reputed company reasonable accommodation requests. Apply To This Job