Position Description

Processes, tracks and appeals clinical denials. Supports and facilitates the design, development and implementation of Utilization Management data collection methodologies and studies in the respective functional areas. Displays and analyzes data to identify trends. Works collaboratively to develop plan of action.

Position Requirements

REQUIRED:
Case Management 1. Graduate of an accredited school of nursing, with strong clinical case management experience 2. Three (3) years experience in Utilization Management/Case Management or related field, with specific experience in the following areas: the application of industry prevalent guideline criteria; knowledge of coding, billing, audit and reimbursement payer methodologies and guidelines. Experience in the collection, interpretation, and presentation of data to medical staff members; and, interaction with managed care companies, including appealing denials. General: 1. Excellent written and verbal communication skills. 2. Ability to communicate effectively with business office, physicians, clinical care team and case management team. 3. Ability to type accurately at an approximate rate of 30 words per minute.
PREFERRED:

Service Area Overview