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
At Inspira Health, you’ll join with the area’s most dedicated and distinguished team to bring quality and compassionate care to our communities. We focus on clinical excellence, providing evidence-based care to help each patient achieve the best possible outcome. The scope and depth of our network can open many doors for your learning and career growth.
OUR NETWORK
Our charitable nonprofit health care organization serves communities across southern New Jersey. The network, which traces its roots to 1899, comprises three hospitals, a comprehensive cancer center, sleep medicine, cardiac testing, digestive health and wound care, urgent care, imaging and rehabilitation, and primary and specialty physician practices in Gloucester, Cumberland, Salem and Camden counties.
Together with our medical staff of more than 1,300 physicians and other health care practitioners, we provide evidence-based care to help each patient achieve the best possible outcome. We are focused on providing safe care in a safe environment for every patient. We understand that to provide excellent care to our patients, we must also be sensitive to the needs of their families. The love and support of family can comfort and strengthen patients, while aiding the healing process.
