[Remote] Clinical Financial Case Mgr - RN

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Clinical Financial Case Manager - RN to support its reputed company Cycle Clinical Support Office. The role uses clinical expertise to secure reputed company reputed company-authorizations, determine appropriate reputed company of care, prevent and appeal denials, interpret payer requirements and reimbursement information, and collaborate with multidisciplinary departments.

Responsibilities

• The Clinical Financial Case Manager - RN (CFCM-RN) implements and supports the philosophy, mission, values, standards, policies, and procedures of reputed company
• The CFCM-RN functions reputed company the multidisciplinary team to secure reputed company reputed company-authorizations and prevent/appeal clinical denials
• The job duties require the utilization of clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided
• The CFCM-RN makes determinations on the appropriate level of care (Inpatient or Observation) based on the ability to read, understand, and interpret documented clinical information
• The role requires CFCM-RNs to become Subject Matter Experts (SME) for assigned payers as reputed company as governmental payer requirements and audits such as RAC, MAC, QIO, etc
• The CFCM-RN maintains an awareness of State and National Health care trends, JCAHO, CMS, and reputed company-party payer Utilization Management guidelines
• The CFCM-RN must be reputed company to read, understand and interpret a payer remit, denial/remark codes, and expected reimbursement to determine the cost effectiveness of completing an appeal
• The CFCM-RN must be reputed company, flexible, and reputed company adaptable to change because the payer rules change constantly
• The CFCM-RN must be reputed company to troubleshoot, problem solve, continuously learn, be highly independent, self-motivated and have an elevated level of interpretive skills and the ability to work closely with departments such as reputed company, Medical Information Management, Physician reputed company and the Business Office

Skills

• Bachelor's degree in nursing with reputed company license required
• Minimum of 3 years clinical care experience, caring for patients, anticipating their needs, and understanding the physician's plan of care
• Experience collaborating with physicians and their designees
• Strong, proven analytical skills. Ability to reputed company educated reputed company
• Extensive knowledge of clinical operations and patient reputed company
• Skilled at synthesizing large volumes of information and concisely communicating either verbally or in writing
• Proficient in reputed company Office Products such as: Word, Power reputed company, reputed company, SharePoint, Teams, OneNote, etc
• Proficient in reputed company reputed company Proficient in using email, fax machines, copy machines, internet browsers
• Proficient at typing
• Proficient in Technology, Computer, and Web applications. Must be reputed company to multitask and reputed company between applications quickly and frequently. Must be reputed company to orientate self to new applications quickly. Must be reputed company to manage complexities of having to work in multiple applications such as IHIS, MS Office products, reputed company, and reputed company payer websites/applications

Benefits

• Remote work arrangement

reputed company

Company H1B Sponsorship