Join our World Class Healthcare Team as a member of our Continuum of Care Services. Your primary responsibilities will be developing and writing comprehensive clinical appeals in response to payer denials. Other duties and responsibilities include tracking, monitoring, and facilitating patient through-put from Ambulatory Surgery through In-patient admission and discharge. You will work to improve process flow by developing new methods for pre-admission patient coordination in alignment with regulatory guidelines and requirements. To qualify you must be a creative problem solver with strong Utilization Management/clinical appeals experience. In this highly interactive role you will collaborate with clinicians and caregivers to achieve goals and further refine on-going programs and initiatives.
The successful candidate must be a NYS Licensed RN with solid Utilization Management and/or Case Management experience and experience writing clinical appeals in response to payer denials. Strong interpersonal skills, proficiency in PC and database management and excellent communication skills are essential. The ability to demonstrate a real understanding of internal mechanisms for hospital care/clinical programs is crucial. Bachelors Degree required – UM/CM certification highly desirable along with knowledge/background in documentation improvement.