RN DENIALS MANAGEMENT

Froedtert Health; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

Froedtert Health is seeking an RN for Denials Management to oversee inpatient denials and coordinate appeals. The role requires significant nursing experience and knowledge in denial management processes. This remote position offers competitive pay and comprehensive benefits, fostering a commitment to diversity and inclusion.

Benefits

Paid time off

Career development opportunities

Medical/dental/vision insurance

Retirement plans

Qualifications

• Minimum of 5 years of acute care nursing experience.
• Prior utilization management, insurance background, and denial management experience preferred.
• Knowledge of ICD-10 Coding Guidelines.

Responsibilities

• Manage inpatient denials for all payers related to medical necessity and clinical validation audits.
• Coordinate the appeal process with physicians, coding, and third-party payers.
• Assist case managers with utilization review issues.

Skills

Interpersonal skills

Analytical skills

Technical writing skills

Education

Bachelor's degree in Nursing

Licensure as a Registered Nurse (RN) in Wisconsin or Multi-state License via NLC

Job description

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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, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.

Experience and Education Requirements:

• Minimum of 5 years of acute care nursing experience; prior utilization management, insurance background, and denial management experience preferred.
• Bachelor's degree in Nursing; licensure as a Registered Nurse (RN) in Wisconsin or a Multi-state License via NLC.
• Previous experience with clinical validation denial review, appeal processes, and knowledge of ICD-10 Coding Guidelines.

Skills Needed:

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

Compensation and Benefits:

Hourly pay range: $36.38 - $56.39, based on experience. Benefits include paid time off, career development opportunities, medical/dental/vision insurance, retirement plans, and more.

Additional Information:

We are an Equal Opportunity Employer committed to diversity and inclusion. For accommodations during the application process, contact us at 262-439-1961.