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Case Manager

Oakwood Healthcare System Type Full time Posted 2/24/2014
Salary - n/a - Starts 4/14/2014
MI - Michigan (All) - Dearborn Referral - n/a -    
Case Manager
Req #:147224
Category:Nursing Professionals
Facility:Oakwood Hospital-Dearborn
Department:Care Management Services
Schedule:Regular/Full time
Shift:Day
Hours per week:40
Job Details:Nurse RN

Job Summary:

Under the direction of the Appeals Manager, integrates cost, quality and utilization to facilitate maximum reimbursement for services rendered utilizing Interqual and Milliman Guidelines. Understands the utilization and denial processes. Employs utilization, clinical, and coding expertise to ensure healthcare services rendered are reimbursed appropriately. Understands payer auditing process and participates as assigned. Initiates and directs the appeal process in response to the audit findings.

Minimum Job Qualifications:

  • Education: Bachelors, or Associate Degree in Nursing.
  • Experience: 3 years clinical experience.
  • Experience in Case Management, Quality Management and/or Appeals Management preferred.
  • Licensure: Current RN license, State of Michigan.
  • Skills & Abilities: Keen analytical, critical thinking and problem-solving skills. Excellent written and verbal communication skills. Ability to meet deadlines and work under pressure. Word processing skills: Word, Excel, Access and OHS systems. Strong organizational skills.