RN DENIALS MANAGEMENT, FCH - ENTERPRISE QUALITY CDI/UR/DM (1009645001)

Discover. Achieve. Succeed. #BeHere

Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility. 

This job is REMOTE.

FTE: 1.000000

Standard Hours: 40.00

Shift: Shift 1

Shift Details: Monday thru Friday 7-3:30 Holidays: None Weekends: None

Job Summary:

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.

EXPERIENCE DESCRIPTION: 

5 years acute nursing or 5 years nursing with relevant denials/appeals experience required. Prior utilization management, insurance background, and denial management experience is preferred. 

EDUCATION DESCRIPTION: 

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 to be eligible for licensure as a Registered Nurse is required. 

TRAINING DESCRIPTION: 

Previous experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 Coding Guidelines. 

SPECIAL SKILLS DESCRIPTION: 

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.  

LICENSURE DESCRIPTION: 

Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). 

Compensation, Benefits & Perks at Froedtert Health 

Pay is expected to be between: (expressed as hourly) $36.38 - $56.39. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.

Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following: 

• 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 

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation. 

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.

5 years acute nursing or nursing with denials/appeals experience required; Bachelor's degree required; current Wisconsin RN license or multi-state NLC license; knowledge of ICD-10 coding guidelines; remote role.

Key Responsibilities

• managing inpatient denials
• coordinating appeals
• improving utilization review

Skills & Tools

ICD-10

Job Details

• Category: Healthcare Services - Nursing
• Seniority: Senior Level
• Commitment: Full Time
• Workplace: Remote — Wisconsin, United States
• Salary: USD 75,670 – 117,291 / year
• Languages: English

Benefits

• Generous paid time off
• Tuition reimbursement
• Retirement plan
• Relocation assistance

About Froedtert Health

A regional health network operating hospitals, clinics, and an academic medical center. — Industry: Healthcare