RN Clinical Resource & Denials Coordinator

LE001 Richmond Medical Center; New York (NY); On-site; USD 86,000 - 98,000; Full time

Job summary

Richmond University Medical Center in New York is seeking a Clinical Resource Manager Coordinator to support case managers with denial management, payer coordination, and data reporting. You will analyze trends, educate on documentation, and act as on-site appeals coordinator for retrospective denials.

The role includes discharge planning and cross-disciplinary collaboration to ensure quality, efficient care and optimal reimbursement.

Qualifications

• Bachelor's degree required (Masters Degree preferred).
• Current NYS RN registration with valid diploma and licensure.
• PRI and Screen certificate required.
• Minimum 5 years RN experience with supervisory utilization review/management.
• Interqual knowledge/experience preferred.
• Proficient in Microsoft Word and Excel.
• SAVVY, Invision, and RAX experience required.

Responsibilities

• Serve as a resource to Case Managers regarding denials and appeals.
• Maintain payer database and update reports as needed.
• Analyze denials and appeals for patterns and trends; educate on documentation.
• Act as on-site appeals coordinator for retrospective denials.
• Coordinate discharge planning and clinical reviews with the care team.
• Facilitate timely patient care and optimize reimbursement.
• Participate in committees and special projects.

Skills

Clinical experience

Supervisory experience

Interqual knowledge

PRI certificate

Screen certificate

SAVVY experience

Invision experience

RAX experience

Education

Bachelor's degree

Master's degree preferred

Tools

Microsoft Word

Microsoft Excel

Job description

Richmond University Medical Center in New York is seeking a Clinical Resource Manager Coordinator to support case managers with denial management, payer coordination, and data reporting. You will analyze trends, educate on documentation, and act as on-site appeals coordinator for retrospective denials.

The role includes discharge planning and cross-disciplinary collaboration to ensure quality, efficient care and optimal reimbursement.