Care Coordination RN: Denials and Appeals Coordinator

  • Inspira Health
  • Vineland, NJ, USA
  • May 03, 2022
Full Time Nursing

Job Description

Includes $10,000 sign-on bonus!

 

The region’s leading network of healthcare providers, Inspira Health is seeking a Care Coordination RN: Denials and Appeals Coordinator to identify, analyze and reports denial trends to the department Director, Business Office, Compliance and Managed Care. We’ll also rely on you to:

  • Manage, track and coordinate third-party payer activity and timeliness or organizational response
  • Serve as a resource to case managers relative to retrospective and concurrent denials and Utilizational Management (UM) processes
  • Collaborate with Director, Physician Advisors, Managed Care, Business Office and Compliance to ensure compliance to state and national rules and regulations along with payer contract
  • Develop educational materials for UM team in conjunction with the Care Coordination Director
  • Participate in development, review and revision of Care Coordination policies and procedures related to the UM process
  • Performs root cause analyses to educate and inform for internal process improvement

Find Your Inspiration.
Team players, leaders, innovators, nurturers, educators, advocates, people with character—these are the people we hire at Inspira. If you enjoy working with a supportive team of professionals in an environment of mutual respect, then consider joining us. At Inspira, each and every person has a genuine impact and an investment in patient care. Our team members enjoy excellent benefits, as well as opportunity for personal and professional growth. 

Equal Opportunity Employer.

Qualifications

  • BBSN required with MSN preferred
  • At least 5 years’ Utilization Review, Discharge Planning and Case Management experience within the last 5 years
  • Ability to coordinate, compile and analyze data
  • Excellent communication and interpersonal skills
  • Ability to negotiate with families, Finance and Managed Care, appeals vendors and third-party payors for optimum care
  • Knowledge of MCG criteria and understanding of Centers for Medicare and Medicaid Services (CMS) guidelines
  • Understanding of the revenue cycle and UM process
  • Proficiency in Microsoft Office
  • Ability to work independently, setting priorities to coordinate care plans efficiently under constraints of managed care guidelines
  • Licensed Registered Nurse in New Jersey required, and Case Management Certification  preferred.

Schedule

Day Shift (Monday-Friday)