[Hiring] Clinical Finance Case Management - RN @The Ohio State University

Role Description

The Clinical Financial Case Manager - RN (CFCM-RN) implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center. The CFCM-RN functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials. The job duties require the utilization of clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided. The CFCM-RN makes determinations on the appropriate level of care (Inpatient or Observation) based on the ability to read, understand, and interpret documented clinical information. The role requires CFCM-RNs to become Subject Matter Experts (SME) for assigned payers as well as governmental payer requirements and audits such as RAC, MAC, QIO, etc. The CFCM-RN maintains an awareness of State and National Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines.

• Ability to communicate in a positive and professional manner using all mediums (email, chat, phone, etc.).
• Financial aspects involve acquiring knowledge of:
• Managed Care
• Scheduling
• Financial Counseling
• Pre-Certification
• Admissions/Discharges/Transfers
• Clinical workflows and documentation
• Revenue Management
• Charge Description Master
• Coding (Diagnosis, HCPCS, Revenue Codes, Procedure Codes, Modifiers, etc.)
• Medical Information Management
• Release of Information
• Case Management
• Utilization Management
• Clinical Documentation Improvement
• Compliance
• Legal
• Finance
• Transplant workflows
• Billing
• Follow Up
• Cash Posting
• Ability to read, understand and interpret a payer remit, denial/remark codes, and expected reimbursement to determine the cost effectiveness of completing an appeal.
• Must be versatile, flexible, and very adaptable to change due to constantly changing payer rules.
• Ability to troubleshoot, problem solve, continuously learn, be highly independent, self-motivated, and possess elevated interpretive skills.
• Ability to work closely with departments such as Legal, Medical Information Management, Physician groups, and the Business Office.

Qualifications

• Bachelor’s degree in nursing with current license required.
• Minimum of 2 years clinical care experience, caring for patients, anticipating their needs, and understanding the physician’s plan of care.
• Experience collaborating with physicians and their designees.
• Strong, proven analytical skills. Ability to make educated decisions.
• Extensive knowledge of clinical operations and patient flow.
• Skilled at synthesizing large volumes of information and concisely communicating either verbally or in writing.
• Proficient in Microsoft Office Products such as: Word, Power Point, Excel, SharePoint, Teams, OneNote, etc.
• Proficient in Adobe Professional.
• Proficient in using email, fax machines, copy machines, internet browsers.
• Proficient at typing.
• Proficient in Technology, Computer, and Web applications.
• Must be able to multitask and move between applications quickly and frequently.
• Must be able to orientate self to new applications quickly.
• Must be able to manage complexities of working in multiple applications such as IHIS, MS Office products, 3M, and all payer websites/applications.

Requirements

• Location: Remote Location
• Position Type: Regular
• Scheduled Hours: 40
• Shift: First Shift
• Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

Benefits

• Equal opportunity employer, including veterans and disability.