RN Denials & Appeals Manager

Air Combat Effectiveness Consulting Group, LLC; San Gabriel (CA); On-site; USD 80,000 - 100,000; Full time

Job summary

Air Combat Effectiveness Consulting Group, LLC is seeking a Denials Case Manager, RN to oversee appeals and ensure compliance with medical necessity standards. This role involves collaboration with different teams to maximize reimbursement and address denial trends.

Ideal candidates should have significant acute care experience and a strong grasp of Utilization Management practices. A current California RN License and BLS certification are mandatory.

Qualifications

• Four years recent acute care experience in a critical care setting.
• Two years of Utilization Management/Case Management experience.
• Current California RN License and BLS Card required.

Responsibilities

• Ensure appeals templates include necessary documentation.
• Knowledge of appeal deadlines and tracking responses.
• Work with payers to resolve underpayment issues.
• Track denial data and identify improvement opportunities.
• Provide training to staff related to denial prevention.

Skills

Negotiation skills

Tracking outcomes

Problem-solving

Clinical knowledge

Education

Graduate of an accredited RN School of Nursing

BSN preferred

Tools

MCG

Intensity of Service/Severity of Illness criteria

Job description

Air Combat Effectiveness Consulting Group, LLC is seeking a Denials Case Manager, RN to oversee appeals and ensure compliance with medical necessity standards. This role involves collaboration with different teams to maximize reimbursement and address denial trends.

Ideal candidates should have significant acute care experience and a strong grasp of Utilization Management practices. A current California RN License and BLS certification are mandatory.