Denial & Appeals RN — Clinical Resource Mgmt (Weekdays)

Hartford HealthCare; Wethersfield (CT); On-site; USD 85,000 - 115,000; Full time

Job summary

Hartford HealthCare seeks a Denial and Appeals Nurse to join its Care Management team in Connecticut. The role focuses on managing payer denials and appeals, handling complex cases across system hospitals with autonomous work style.

The position requires an RN, BSN preferred, and five years of relevant experience in case management or utilization management. Collaboration with Medical Director and Physician Advisor staff is essential to craft sound appeal letters and maintain complete

Qualifications

• Education: Registered Nurse; BSN preferred.
• Five years of relevant case management or utilization management experience.
• Current State of Connecticut RN license required; CCM/CPUM or similar certification preferred.

Responsibilities

• Follow standard work processes to manage denials and appeals.
• Ensure activities are completed within regulatory and payer timeframes.
• Develop and maintain collaborative relationships with internal and external stakeholders to obtain information for clinical appeal.
• Assist in composing factually sound appeal letters with Medical Director/Physician Advisor input.
• Maintain documentation and an accurate appeals record in the database.
• Assist in analysis and documentation of root causes for denials.
• Provide education to stakeholder groups on findings and mitigation strategies.
• Identify denial/appeal trends with multi-disciplinary team to support improvement strategies.
• Other duties as assigned.

Skills

Communication

Interpersonal skills

Critical thinking

Negotiation

MS Office

Education

RN license CT

BSN preferred

Tools

EPIC

Job description

Hartford HealthCare seeks a Denial and Appeals Nurse to join its Care Management team in Connecticut. The role focuses on managing payer denials and appeals, handling complex cases across system hospitals with autonomous work style.

The position requires an RN, BSN preferred, and five years of relevant experience in case management or utilization management. Collaboration with Medical Director and Physician Advisor staff is essential to craft sound appeal letters and maintain complete