Top 952 Nurse Jobs in Ooltewah Tn

Clinical Review and Appeals Specialist
Life Care Centers of America —Cleveland, TN
- Weekends as needed
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse (RN)
Opulent Private Care Services —Dalton, GA
- $50 - $52 an hour
- Part-time
- CPR Certification
- Current TB test
- Patient monitoring
Quick Apply
3d
Care Manager Registered Nurse
Monogram Health Inc —Dalton, GA
- Weekends as needed
- Hybrid work
- Nursing
- Vital signs
- RN License
- Paid holidays
- Health insurance
Quick Apply
RN Assistant Director of Nursing
Caris HealthCare —Chattanooga, TN
- $76,000 - $84,000 a year
- Nursing
- RN License
- Computer literacy
- Paid training
- Mileage reimbursement
Quick Apply
Enterostomal Therapist - $10k Sign on Bonus - FT
Erlanger Health System —Chattanooga, TN
- Full-time
- Nursing
- RN License
- Hospital
Clinical Consultant
Unum Group —Chattanooga, TN
- $53,300 - $100,700 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Loan repayment program
- Disability insurance
RN Nurse Triage (Remote Position)
Center for Sports Medicine & Orthopaedics —Chattanooga, TN
- Part-time
- Hybrid work
- CPR Certification
- RN License
- Customer service
- Disability insurance
- Health insurance
Quick Apply
5d
Case Manager
BlueCross BlueShield of Tennessee —Chattanooga, TN
- Full-time
- Remote
- RN License
- Computer literacy
- Mid-level
4d
Full-Time/Part-Time Registered Nurse
Summit Spine and Joint Centers —Dalton, GA
- Part-time
- RN License
- BLS Certification
- Mid-level
Quick Apply
HSA Registered Nurse (RN)
TK Health —Cleveland, TN
- $85,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Paid holidays
- Health insurance
Quick Apply
Local Per Diem Registered Nurse (RN) - Hospital
connectRN —Chattanooga, TN
- $47 an hour
- PRN
- Acute care
- RN License
- BLS Certification
- Health insurance
- Flexible schedule
1d
$53-55 School Registered Nurse (RN) | Monday, Tuesday, Wednesday & Friday | Cohutta, GA
HomeCare Roots —Cohutta, GA
- $50 - $55 an hour
- Part-time
- Background check
- CPR Certification
- Patient monitoring
Quick Apply
4d
Home Health Registered Nurse | URGENT | Earn Up to $113,000/YR PLUS Mileage!
Ascendo Resources —Hamilton County, TN
- $98,750 - $113,000 a week
- Full-time
- RN License
- Mid-level
- Home Health
- Mileage reimbursement
- Disability insurance
Quick Apply
1d
Director of Nursing
PruittHealth —Fort Oglethorpe, GA
- Full-time
- Background check
- Skilled nursing facility
- RN License
- Profit sharing
- Health savings account
14d
Nurse Liaison - Full-time
Siskin Hospital for Physical Rehabilitation —Chattanooga, TN
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
11d
Director of Nursing Memory Care
Morning Pointe Senior Living —Ooltewah, TN
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
12d
Wellness Director
StoryPoint —Chattanooga, TN
- Weekends as needed
- Mid-level
- Travel
- Leadership
- Health insurance
- Dental insurance
Quick Apply
4d
Oncology Nurse Navigator
One Stop Recruiting —Cleveland, TN
- $40 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Outpatient experience
- Paid holidays
- Dental insurance
Quick Apply
RN Registered Nurse Full-Time Night Shift -Hamilton County
QCHC Inc —Chattanooga, TN
- $45 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid holidays
- Health insurance
Quick Apply
12d
Registered Nurse (RN) - Certified Home Health - earn $58.67 per point
connectRN —Ringgold, GA
- $60.67 per point
- PRN
- CPR Certification
- RN License
- Driver's License
- Mileage reimbursement
- Health insurance
1d

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Clinical Review and Appeals Specialist

Life Care Centers of America -
Cleveland, TN

Quick Apply

Job Details

Full-time

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
Life insurance

Qualifications

Confidential information handling
Long-term care regulations
Medicare
RN License
HCQM Certification
Employee relationship building
English
Medicare regulations
Team management
Clinical outcome improvement
Productivity software
Clinical quality assurance standards
Healthcare compliance
Quality assurance experience within healthcare
Implementing nursing quality improvement initiatives

Full Job Description

Clinical Review and Appeals Specialist
Life Care Centers of America
Cleveland, TN

Position Summary

The Clinical Review and Appeals Specialist timely reviews audit requests and denied claims from all payors related to medical necessity, appropriate setting/status determination, authorizations, and appropriate length of stay. Ensures all audits and/or denied claims are accurately worked and appealed to obtain maximum reimbursement and minimize recoupment in accordance with all applicable laws, regulations, and Life Care standards.
Reports to Director of Clinical Review and Appeals

Working Conditions

Works in office setting as well as facility sites (e.g., division office, off-site venues, facilities)
Subject to frequent interruptions
Involved with patients, associates, visitors, government agencies/personnel, etc. under all conditions and circumstances
Subject to hostile and emotionally upset patients, family members, etc.
Works beyond normal working hours, on weekends and holidays, and in other positions temporarily as necessary
Subject to falls, burns from equipment, odors, etc. during facility visits

Education, Experience, and Licensure/Certifications

Must have Registered Nursing (RN) degree (RN) from an accredited college or university
Must be currently licensed/registered in applicable state. Must maintain an active Registered Nursing (RN) license in good standing throughout employment
Or must have minimum an Associate’s/Bachelor’s degree from accredited PT/PTA or OT/OTA program OR minimum Master’s degree from SLP program
May have a certification in Healthcare and Quality Management (HCQM)
Must have extensive knowledge of the RAI process, Medicare regulations, Quality Measures, and PDPM
Must have experience in managing multiple people and facilities
Certification in HealthCare Compliance (CHC) preferred
Must have knowledge of the Quality Reporting Program

Specific Requirements

Must be willing and able to travel, including air travel
Must be proficient in Word, Excel, and e-mail
Must have excellent verbal and written communication skills
Must maintain a positive attitude and positive communication supporting Life Care goals and initiatives
Must be able to follow directions of supervisor
Must communicate and function productively with associates at the facility, regional, and division levels
Must possess the ability to make independent decisions when circumstances warrant such action
Must be knowledgeable of nursing practices and procedures as well as the laws, regulations, and guidelines governing nursing functions in the post-acute rehab and long-term care facility
Must have the ability to implement and interpret the programs, goals, objectives, policies, and procedures of the Clinical Services department
Must perform proficiently in all applicable competency areas (See position competencies for additional details)
Maintains professional working relationships with all associates, vendors, etc
Maintains confidentiality of all proprietary and/or confidential information
Must understand and follow company policies including harassment and compliance procedures
Displays integrity and professionalism by adhering to Life Care’s Code of Conduct and completes mandatory Code of Conduct and other appropriate compliance training

Essential Functions

Must be able to effectively direct the management of clinical and/or rehabilitation denials in accordance with Federal guidelines and company benchmarks
Must be able to implement a denial prevention program that focuses on documentation quality: manage denial process to achieve benchmarks
Must be able to collect, review and analyze current audit data. Must be able to identify trends and initiate clinical quality improvement initiatives, focus on improving clinical quality indicators, outcomes, and financial metrics
Must be able to oversee collection and utilization of operational and benchmarking data to recommend and set targets for improvement based on research of industry best practices and recommending process improvements
Must be able to stay current with any reimbursement or MDS and Rehab updates and provide education opportunities when needed
Must be able to provide education as needed regarding updates or changes to the CMS RAI Manual or Skilled Nursing Facility Regulations that impact reimbursement
Must be able to serve as subject matter expert for appeals and denials and as a resource for clinical services team and provide education to promote reduction in denials
Must be able to answer questions related to audits and appeals
Must be able to develop tracking systems to provide accurate audit and denial data
Must be able to document and log audit and appeal data timely
Must be able to complete clinical review of appropriate pre- and post-claim denials.
Must be able to prepare clinical discussions and appeal letters for appeal
Must be able to ensure submission of appeals to the payors within allotted time frames to prevent fiscal penalties
Must be able to assist clinical corporate with development of policies, procedures, education modules, and other training materials, related to coding, denials and accurate billing, when requested
Must be able to complete compliance review to include researching and supporting questions related to Federal guidelines and state practice acts
Must be able to serve as therapy liaison with Compliance, Medicare Claims and IT
Must be able to serve as link between Therapy and Compliance related to coding issues and initiatives and ensures accurate ICD-10 and HCPC coding
Must exhibit excellent customer service and a positive attitude
Must be able to assist in the evacuation of patients
Must demonstrate dependable, regular attendance
Must be able to concentrate and use reasoning skills and good judgment
Must be able to communicate and function productively within an interdisciplinary team
Must be able to sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours
Must be able to read, write, speak, and understand the English language
Must be able to lift weight as deemed appropriate for the position

An Equal Opportunity Employer

Job Type: Full-time

Benefits:

401(k)
Dental insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Vision insurance

Ability to Commute:

Cleveland, TN 37312 (Required)

Ability to Relocate:

Cleveland, TN 37312: Relocate before starting work (Required)

Work Location: In person

Quick Apply

Refine Your Search

nurse jobs in ooltewah tn

Clinical Review and Appeals Specialist

Registered Nurse (RN)

Care Manager Registered Nurse

RN Assistant Director of Nursing

Enterostomal Therapist - $10k Sign on Bonus - FT

Clinical Consultant

RN Nurse Triage (Remote Position)

Case Manager

Full-Time/Part-Time Registered Nurse

HSA Registered Nurse (RN)

Local Per Diem Registered Nurse (RN) - Hospital

$53-55 School Registered Nurse (RN) | Monday, Tuesday, Wednesday & Friday | Cohutta, GA

Home Health Registered Nurse | URGENT | Earn Up to $113,000/YR PLUS Mileage!

Director of Nursing

Nurse Liaison - Full-time

Director of Nursing Memory Care

Wellness Director

Oncology Nurse Navigator

RN Registered Nurse Full-Time Night Shift -Hamilton County

Registered Nurse (RN) - Certified Home Health - earn $58.67 per point

I want to receive the latest job alert for nurse in ooltewah tn

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