[Hiring] RN DENIALS MANAGEMENT HRLY, FCH - ENTERPRISE QUALITY CDI/UR/DM @Froedtert

Role Description

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third party payers, and third 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.

Qualifications

• A minimum of 5 years of acute care nursing experience is required.
• Prior utilization management, insurance background, and denial management experience is preferred.
• 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.

Requirements

• Previous experience with clinical validation denial review and appeal processes.
• Knowledge of ICD-10 Coding Guidelines.
• Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel.
• Analytical skills necessary to prepare statistical reports and develop solutions to problems.
• Technical writing ability for appeal letters and reports.
• Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).

Benefits

• Paid time off
• Growth opportunity - Career Pathways & Career Tuition Assistance, CEU opportunities
• Academic Partnership with the Medical College of Wisconsin
• Referral bonuses
• Retirement plan - 403b
• Medical, Dental, Vision, 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