Top 7828 Risk manager/rn Jobs

Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
Director of Emergency Care
Amberwell Health Hiawatha —Hiawatha, KS
- Weekends as needed
- Nursing
- RN License
- BLS Certification
RN - Emergency Department
Curry Health Network —Medford, OR
- $38.25 - $58.39 an hour
- Part-time
- Microsoft Word
- Background check
- Nursing
- Relocation assistance
Quick Apply
Clinical Nurse Manager - Maternal Newborn - Children's Hospital
University of Missouri Health Care —Columbia, MO
- $108,971 - $177,590 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Paid holidays
- Health insurance
RN Case Manager
Frontier Home Health LLC —Pueblo, CO
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
Branch Clinical Manager (RN) Home Health
Adaptive Home Health —Detroit, MI
- Full-time
- RN License
- Home Health
- Senior level
Quick Apply
RN Unit Manager
Aloha Nursing Rehab Centre —Kaneohe, HI
- From $96,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Free parking
- Paid holidays
Quick Apply
Dialysis Nurse Manager - $10,000 Sign-on Bonus
Dialysis Clinic, Inc. —Dulce, NM
- $100,000 - $120,000 a year
- Online Application
- Nursing
- RN License
- Mid-level
- Paid training
- Wellness program
Quick Apply
Administrative Nursing Supervisor (ANS-RN)
Fairview Health Services —Princeton, MN
- $52.00 - $75.11 an hour
- 12 hour shift
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
RN Case Manager
Community Care, Inc. —Waukesha, WI
- Full-time
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
6d
Nurse Practitioner - Part-Time
WORKCARE INC —South Haven, MI
- $113.69 an hour
- Part-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Quick Apply
LPN/RN Unit Manager
Stonecreek Health and Rehabilitation —Paducah, KY
- Full-time
- CPR Certification
- Skilled nursing facility
- Vital signs
- Health insurance
- Dental insurance
Quick Apply
Nurse Manager Maternity/Post Partum and Special Care Nursery 40hrs
Merrimack Health —Lawrence, MA
- Full-time
- Nursing
- RN License
- Mid-level
Certified Surgical Technologist
Curry Health Network —Medford, OR
- Full-time
- Background check
- Anatomy knowledge
- Microsoft Excel
Quick Apply
RN - MENTAL HEALTH - ACT PROGRAM - CHARLOTTESVILLE
Region Ten Community Services Board —Charlottesville, VA
- $25.43 - $38.15 an hour
- Weekends as needed
- CPR Certification
- Nursing
- Clean driving record
- Disability insurance
Quick Apply
RN Clinical Manager
Lakewood Memory Care and Assisted Living —Brookfield, WI
- Full-time
- Background check
- Experience working with individuals with developmental disabilities
- RN License
- Health savings account
- Health insurance
Quick Apply
Nursing Supervisor - RN or LPN
Ohio Living —Waynesville, OH
- Full-time
- Nursing
- Microsoft Excel
- RN License
Quick Apply
11d
Nurse Manager - ICU
Samaritan Health Services —Corvallis, OR
- Nursing
- RN License
- BLS Certification
Nurse Care Manager
Hearth INC —Roxbury, MA
- From $95,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Wellness program
- Disability insurance
Quick Apply
Registered Nurse - Racine
Community Care, Inc. —Racine, WI
- Full-time
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
3d

I want to receive the latest job alert for risk manager/rn

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

risk manager/rn jobs near

Nurse Practitioner jobs in South Haven, MI

Registered Nurse jobs in Remote

Maternity Nurse jobs in Columbia, MO

Maternity Nurse jobs in Lawrence, MA

Registered Nurse Manager jobs in Corvallis, OR

Registered Nurse jobs in Racine, WI

Branch Manager jobs in Detroit, MI

Clinical Nurse Manager jobs in Brookfield, WI

Labor Delivery Nurse Residency Program jobs in Georgia

Grady Hospital Registered Nurse jobs in Atlanta, GA

Nurse Practitioner jobs in Hampton Roads, VA

Nurse Practitioner jobs in Lawrence, KS

Nurse Practitioner jobs in Brandon, FL

Women Health Nurse Practitioner Jobs jobs in San Diego, CA

Nurse Visa Sponsorship jobs in Washington State

Nurse Practitioner jobs in Spartanburg, SC

Registered Nurse jobs in Montgomery, AL

Registered Nurse jobs in Ellicott City, MD

Public Health Nurse jobs in Macomb County, MI

Registered Nurse jobs in Boerne, TX

Denials & Appeals Administrator (RN)

Boston Medical Center -
Remote

Apply Now

Job Details

Full-time
$43.03 - $62.50 an hour

Benefits

Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
403(b)
Opportunities for advancement

Qualifications

Nursing
RN License
Regulatory compliance
Coding for hospital billing
Medical billing data reporting
Bachelor's degree
Financial report interpretation
Team management
Financial data management
Healthcare team management
Technical skills instruction
Clinical documentation standards
Nursing
Financial compliance

Full Job Description

Denials & Appeals Administrator (RN)

49233

Remote, United States

Full Time

POSITION SUMMARY:

The RN Appeal Administrator will be responsible for the Pre-denial/ Denial and appeal process in addition to Utilization Review, to validate the patient’s placement to be at the most appropriate level of care based on nationally accepted admission criteria. The Appeal/ UR Administrator uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient’s expected length of stay. The Appeal/ UR Administrator secures authorization for the patient’s clinical services through timely collaboration and communication with payers as required. The Appeal/ UR Administrator follows the UR process, in addition to the pre-denial and denial/appeal process as defined in the attached job description and in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.

The Denials and Appeals Administrator assesses, plans, coordinates, and evaluates initial and ongoing denials. He/She obtains information on all denials occurring as related to observation and inpatient stays. The Denials and Appeals Administrator researches and responds to denials in a timely fashion. He/She communicates with multiple members of the clinical team in clear concise language taking the lead in the resolution of the clinical denials. He/ she identifies trends and responds to the trends by recommending changes in practice and or documentation of the clinical providers to promote a reduction in the denials trends. The Denials and Appeals Administrator collects and trends the data for the return on investment as it relates to denials and reports that data to the Director Care management for review.

The Denials and Appeals Administrator combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Collaborates with physicians, Case Managers, revenue cycle personnel and payers to appeal denials. Performs activities related to insuring a denial appeals process that includes monitoring for patterns and trends and maximizing reimbursement within regulatory requirements.

Position: Denials & Appeals Administrator (RN)

Department: Denials Access

Schedule: 40 Hours Days

JOB REQUIREMENTS

EDUCATION:

Requires Bachelor's Degree in Nursing or related field. Graduate degree preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Licensed to practice professional nursing as a registered nurse in the Commonwealth of Massachusetts.

EXPERIENCE:

Minimum 5 years or more related experience preferably in a healthcare case management and patient insurance/billing environment3-4 years supervisory experience preferred.
Medical records coding experience.is desirable.

KNOWLEDGE AND SKILLS:

Work requires a comprehensive knowledge of clinical documentation and medical coding, and a working knowledge of patient financial billing regulations/requirements, reimbursement, managed care in order to understand the clinical and billing systems; review, interpret, and analyze clinical and patient financial reports and data; and plan, coordinate and prepare for corrections to accounts. Such knowledge is generally acquired through completion of a Bachelor's degree and 5 years of experience in Case Management and an HMO setting.
Work requires a comprehensive understanding of medical records coding, patient billing policies and procedures and health insurance standards, as well as knowledge of supervisory/managerial techniques and principles in order to control hospital financial billing activities. Establish and implement financial policies and plans; assist with the install of new modules; provide training for staff at various levels. Such knowledge is normally acquired during 5 years or more progressively responsible experience in clinical areas and patient financial management environment.
Work requires advanced interpersonal skills necessary to work with physicians, hospital directors and managers to affect changes in clinical and fiscal operations, policies and procedures; to provide guidance, communicate and interpret complex patient billing and compliance information.

Compensation Range:

$43.03- $62.50

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.

Apply Now

Refine Your Search

risk manager/rn jobs

Denials & Appeals Administrator (RN)

Director of Emergency Care

RN - Emergency Department

Clinical Nurse Manager - Maternal Newborn - Children's Hospital

RN Case Manager

Branch Clinical Manager (RN) Home Health

RN Unit Manager

Dialysis Nurse Manager - $10,000 Sign-on Bonus

Administrative Nursing Supervisor (ANS-RN)

RN Case Manager

Nurse Practitioner - Part-Time

LPN/RN Unit Manager

Nurse Manager Maternity/Post Partum and Special Care Nursery 40hrs

Certified Surgical Technologist

RN - MENTAL HEALTH - ACT PROGRAM - CHARLOTTESVILLE

RN Clinical Manager

Nursing Supervisor - RN or LPN

Nurse Manager - ICU

Nurse Care Manager

Registered Nurse - Racine

I want to receive the latest job alert for risk manager/rn

Related Searches

Explore jobs in more locations

Denials & Appeals Administrator (RN)

Job Seeker Tools

Employer Tools

Browse

Stay Connected