[Hiring] Denials Management Registered Nurse @Community Health Network

Role Description

The primary role of the Denial Management Registered Nurse is to research, analyze, document and appeal third party payer denials involving medical necessity or clinical issues. The Denial Management RN will work from home after orientation completion, and is required to maintain productivity requirements set by leadership.

Qualifications

• 5 years of clinical experience required.
• 1-3 years Case management preferred.
• 1-3 years experience with Third party payer (Medicare) preferred.
• Previous Denials experience highly preferred.
• Knowledge of Epic operating system preferred.
• A working knowledge of the following:
  • Utilization Management and Review
  • Clinical and Patient Financial Documentation Systems
  • Level of Care review
  • Criteria Payer Appeals guidelines
  • Regulatory guidelines
  • Transitional Care (Required)

Requirements

• Graduate of National League for Nursing or Commission on Collegiate Nursing Education accredited school of nursing.
• Associates or Bachelor of Science in Nursing is required.
• Licensed as a Registered Nurse by the Indiana Professional Licensing Agency required.

Company Description

Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you.