Case Manager - Revenue Management

Location
Englewood, CO
Salary
Competitive
Posted
Nov 14, 2017
Closes
Dec 14, 2017
Specialty
Case Management
Contract Type
Permanent
Hours
Full Time
Centura Health connects individuals, families and neighborhoods across Colorado and western Kansas with more than 21,000 of the most talented hearts and minds in medicine.

Through Centura Health’s 17 hospitals, two senior living communities, health neighborhoods, physician clinics, Flight for Life® Colorado, home care and hospice services, we offer a diverse range of work settings in a Colorado or Kansas community you will love to call home.

Enjoy amazing people, competitive pay, some of the best benefits in the industry and plenty of opportunity for professional growth and development.

If you’re ready to discover the difference of working for a fully-integrated health system with a non-profit, faith-based mission to care, we look forward to receiving your application.

Job Description/Job Posting ID: 117406

Recruiter Contact: MandyGray@Centura.org

Schedule: 1.00 FTE- FT Days

POSITION SUMMARY

The RN Case Manager within Revenue Management is a part of the Denials Management Team and may be responsible for reviewing either inpatient or outpatient denials.  Using a collaborative, interdisciplinary approach with Revenue Management, Hospital Case Management Directors and the Hospital Revenue Management Team, the RN Case Manager researches available information with the objective of providing clinical expertise and guidance in order to facilitate claim payment and reimbursement at the highest level.

 

EDUCATION REQUIREMENTS

RN licensed in state of CO

Working knowledge of Milliman Care Guidelines or InterQual

 

WORK EXPERIENCE REQUIREMENTS

4 years clinical experience as a Registered Nurse

2 years with experience in Case Management to include discharge planning and utilization review. 

Coding or Clinical Documentation Improvement helpful

Prior supervisory/management experience preferred. 

Excellent verbal and written communications

High level critical thinking skills and problem solving

Strong Organization skills

Ability to multitask

 

LICENSE/CERTIFICATIONS

RN licensed in state of Colorado

 

 POSITION DUTIES

  • Reviews denials forwarded by Appeals Specialists either formally or informally

  • Researches Medical Records and Payor denial reasons

  • Creates appeal letter specific to denial reasons and clinical scenario

  • Remains up to date on medical necessity guidelines, Standard of Practice and criteria used to determine levels of care

  • Keeps up to date with State and Federal Regulations

  • Maintains timely filing deadlines as established by Payor contract

  • Enters proper documentation in EPIC, Allscripts, Meditech or other documentation systems being used

  • Maintains collaborative relationship with hospital stakeholders in an effort to get claims resolved

  • Attends Case Management, Utilization Management or other meeting to educate, inform and provide consulting services to hospital facilities and stakeholders with the objective of identifying barriers effecting payment

  • Keeps up to date with trends in denials and appeals outcomes

  • Maintains collaborative relationships and provides feedback regarding day to day processes with the Denials and Appeals Team.  This may include changing trends we have identified

  • Provides clinical education to Denials and Appeals Team when requested

 

Physical Requirements

X Sedentary Work - prolonged periods of sitting and exert/lift up to 10 lbs force occasionally

 

ZIPJOB

 

Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V. 

More jobs like this