[Hiring] Clinical Financial Case Manager - 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.

• Determines the appropriate level of care (Inpatient or Observation) based on clinical information.
• Becomes Subject Matter Experts (SME) for assigned payers and governmental payer requirements.
• Maintains awareness of State and National Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines.
• Acquires knowledge of Managed Care, Scheduling, Financial Counseling, Pre-Certification, Admissions/Discharges/Transfers, Clinical workflows and documentation, Revenue Management, Charge Description Master, Coding, Medical Information Management, Release of Information, Case Management, Utilization Management, Clinical Documentation Improvement, Compliance, Legal, Finance, Transplant workflows, Billing, Follow Up, Cash Posting.
• Reads, understands, and interprets payer remits, denial/remark codes, and expected reimbursement.
• Must be versatile, flexible, and adaptable to change due to constantly changing payer rules.
• Ability to troubleshoot, problem solve, continuously learn, and 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 with the ability to make educated decisions.
• Extensive knowledge of clinical operations and patient flow.
• Skilled at synthesizing large volumes of information and communicating concisely.
• Proficient in Microsoft Office Products: 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.
• Ability to multitask and manage complexities of working in multiple applications.

Requirements

• 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

• Remote Location.
• Regular Position Type.
• Scheduled Hours: 40.
• Shift: First Shift.