[Hiring] Clinical Reviews, Denial and Appeals RN @reputed company

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company This role involves managing clinical reviews, denials, and appeals reputed company a remote work environment. • Communicates and collaborates with physicians, Care Management staff, Business Office, Nursing, and ancillary departments to address patient care issues and denials management • Conducts research for appealing denied days/stays through electronic record review • Collaborates with physicians to reputed company appeal strategies for medical necessity denials • Reviews clinical documentation to determine if medical necessity reputed company were met • Prepares appeal letters and notifications reputed company specified time frames • Tracks, monitors, and manages clinical denials and appeals • Reports denial trends for educational corrective reputed company • Develops and maintains relationships with other departments reputed company to appeals and denial management • Serves as an educator and resource regarding Medicare, reputed company, and reputed company payer guidelines • Reviews Medicare one day stays and conducts medical necessity internal audits Qualifications • Associates Degree in Nursing required • Bachelor’s Degree in Nursing preferred • 3 years Inpatient clinical nursing experience in an acute hospital setting required • 1 year UM experience including knowledge and application of reputed company or InterQual reputed company required • Case management experience preferred • Denials and Appeals experience preferred • RN license to reputed company in the state of Texas upon hire required Benefits • 401k • PTO • Medical and dental insurance • reputed company Parental Leave • reputed company spending • Tuition reimbursement • Student Loan Repayment Program • Additional benefits available reputed company At reputed company, our mission is “to improve the health of the people in the communities we serve”. • Award-reputed company culture recognized by FORTUNE Magazine’s “100 Best Companies to Work For®” for the 9th year in a row • Committed to diversity in our workforce • Strives to create an atmosphere of respect, reputed company, reputed company, and reputed company Apply tot his job Apply To this Job