Top 6036 Utilization 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
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
Clinical Review & Correspondence RN
Cohere Health —Remote
- $31 - $35 an hour
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health savings account
Quick Apply
Utilization Review Nurse
Cobalt Benefits Group LLC —Orlando, FL
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
RN Case Manager
Zócalo Health —Remote
- $85,000 a year
- Full-time
- Remote
- RN License
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Program Manager - Cardiac Rehabilitation
SouthEast Alaska Regional Health Consortium —Juneau, AK
- $36.46 - $51.29 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- BLS Certification
- Paid parental leave
- Disability insurance
Quick Apply
Registered Nurse Manager (RN)
Pillar of Cedar Valley Nursing and Rehabilitation —Waterloo, IA
- $45 an hour
- Full-time
- CPR Certification
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse - Case Manager
SSM Health —Madison, WI
- Part-time
- Nursing
- RN License
- Hospital
- Paid parental leave
- Health insurance
Utilization Review Nurse
HAMASPIK CHOICE INC —Spring Valley, NY
- $45 - $47 an hour
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Clinical Manager
United Energy Workers Healthcare —Kansas City, MO
- $38 - $43 an hour
- Nights as needed
- CPR Certification
- RN License
- BLS Certification
13d
Home Health Care RN Case Manager
ACE Home Health Care —Howard City, MI
- $65 - $80 a year
- Full-time
- Vital signs
- RN License
- HIPAA
- Continuing education credits
- Mileage reimbursement
Quick Apply
Care Manager - Registered Nurse
Crouse Hospital —Syracuse, NY
- $80,000 - $86,000 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
Nurse Manager, Behavioral Health Services
Signet Health Corporation —Greensboro, NC
- $110,000 - $120,000 a year
- Full-time
- Nursing
- Psychiatry
- RN License
- Disability insurance
- Health insurance
Nurse Educator (RN)
Wake Robin Corporation —Shelburne, VT
- $36.70 - $44.77 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Disability insurance
Quick Apply
RN Case Manager
Community LIFE —Homestead, PA
- $72,000 - $85,000 a year
- Full-time
- Nursing
- RN License
- Word processing
- Travel reimbursement
- Mileage reimbursement
Quick Apply
13d
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
- Nursing
- RN License
- Mid-level
- Travel reimbursement
- Disability insurance
Quick Apply
Branch Clinical Manager (RN) Home Health
Adaptive Home Health —Detroit, MI
- Full-time
- RN License
- Home Health
- Senior level
Quick Apply
OAK - Charge RN
MEDBRIDGE VENTURES LLC —Oakland, CA
- $150,000 - $180,000 a year
- Nursing
- RN License
- PALS Certification
Quick Apply
Registered Nurse Case Manager
Confidential —Peabody, MA
- $90,000 - $100,000 a year
- Full-time
- Background check
- Nursing
- RN License
- Free parking
- Health savings account
Quick Apply
13d

I want to receive the latest job alert for utilization 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

utilization manager rn jobs near

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

utilization manager rn jobs

Denials & Appeals Administrator (RN)

Claims - Care Manager, RN, Claims

Clinical Review & Correspondence RN

Utilization Review Nurse

RN Case Manager

Program Manager - Cardiac Rehabilitation

Registered Nurse Manager (RN)

Registered Nurse - Case Manager

Utilization Review Nurse

Clinical Manager

Home Health Care RN Case Manager

Care Manager - Registered Nurse

Nurse Manager, Behavioral Health Services

Nurse Educator (RN)

RN Case Manager

HOME CARE - RN CASE MANAGER

Patient Care Manager - Floater (RN)

Branch Clinical Manager (RN) Home Health

OAK - Charge RN

Registered Nurse Case Manager

I want to receive the latest job alert for utilization manager rn

Related Searches

Explore jobs in more locations

Denials & Appeals Administrator (RN)

Job Seeker Tools

Employer Tools

Browse

Stay Connected