RN DENIALS MANAGEMENT

Froedtert Health; United States; Remote; Full time

Job summary

A leading healthcare organization is seeking a dedicated individual to manage inpatient denials related to medical necessity and clinical validation audits. This role involves coordinating appeals with various stakeholders and improving processes in denial management. Candidates should have substantial nursing experience and a bachelor's degree. The position offers competitive hourly pay and a comprehensive benefits package.

Benefits

Paid time off

Career development opportunities

Referral bonuses

Retirement plans

Medical/dental/vision insurance

Employee assistance programs

Qualifications

• Minimum of 5 years of acute care nursing experience required.
• Experience with clinical validation denial review and appeal processes.

Responsibilities

• Manage inpatient denials for all payers related to medical necessity.
• Coordinate the appeal process with physicians and auditors.
• Assist case managers with utilization review issues.

Skills

Interpersonal skills

Analytical skills

Technical writing skills

Education

Bachelor's degree

Tools

ICD-10 Coding Guidelines

Job description

Discover. Achieve. Succeed. #BeHere

Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility.

This job is REMOTE.

FTE: 1.000000

Shift: Shift 1

Job Summary:

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits. Coordinates the appeal process with physicians, coding, third-party payers, and auditors. Assists case managers with utilization review issues and recommends process improvements in utilization review and denial management. Performs other duties as assigned.

Experience Description:

Minimum of 5 years of acute care nursing experience required. Prior utilization management, insurance background, and denial management experience preferred.

Education Description:

Bachelor's degree required. Must have professional knowledge of nursing theory and practice, typically acquired through at least four years of education at an accredited School of Nursing, qualifying for licensure as a Registered Nurse.

Training Description:

Experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 Coding Guidelines.

Special Skills Description:

Interpersonal skills for effective communication with hospital personnel. Analytical skills for statistical reporting and problem-solving. Technical writing skills for appeal letters and reports.

Licensure Description:

Current Wisconsin Registered Nurse License or Multi-state Nursing License from a participating NLC state required.

Compensation, Benefits & Perks at Froedtert Health:

Hourly pay ranges from $36.38 to $56.39, based on experience. Benefits include paid time off, career development opportunities, partnerships with the Medical College of Wisconsin, referral bonuses, retirement plans, medical/dental/vision insurance, employee assistance programs, and other work-life benefits.

Our health network includes ten hospitals, nearly 2,000 physicians, and over 45 clinics, serving patients across the Midwest and beyond.

We are an Equal Opportunity Employer committed to diversity and inclusion. Protected veterans are encouraged to share their status. We maintain a drug-free workplace and provide accommodations during the application process. For assistance, contact us at 262-439-1961.