Role OverviewResponsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes. Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process.
What You Will Do
Utilizes Payer specific screening tools to assist in the determination process regarding level of service and medical necessity. Identifies and manages concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
Why It Might Be a Fit
Preferred: 3 years clinical nursing (RN) experience and 1 year UR/CM/QM experience or 3 years experience as Clinical Social Worker. Basic understanding of Medicare, Medicaid and managed care. Excellent verbal and written communication skills, problem solving, critical thinking and conflict resolution.
Requirements
- Graduate of an accredited School of Nursing
- Licensure from the State of New Jersey as a Registered Nurse
- Case Management Certification (requirement within one year of hire beginning April 1, 2015)
- 3 years clinical nursing (RN) experience and 1 year UR/CM/QM experience or 3 years experience as Clinical Social Worker
Benefits
- medical/prescription insurance
- dental insurance
- vision insurance
- health and dependent care flexible spending accounts
- 403(b) (401(k) subject to collective bargaining agreement)
- paid time off
- paid sick leave as provided under state and local paid sick leave laws
- short-term disability
- optional long-term disability
- colleague and dependent life insurance
- supplemental life and AD&D insurance
- tuition assistance
- employee assistance program that includes free counseling sessions
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