RN Recovery Nurse Appeals Specialist - Revenue Cycle - Remote

Ochsner Health; New Orleans (LA); Remote; USD 60,000 - 90,000; Full time

Job summary

Ochsner Health is seeking a Registered Nurse to review compliance and assess medical necessity. The role offers competitive salary, potential for bonuses, and opportunities for career growth within a supportive healthcare environment. Ideal candidates will be experienced and possess a valid RN license.

Benefits

Career advancement opportunities

Flexible work schedule options

Supportive work environment

Bonus opportunities

Qualifications

• Minimum 3 years of hospital-based experience as RN.
• Current State of Louisiana RN License required.
• Experience in Case Management or Utilization Review preferred.

Responsibilities

• Review medical information for compliance and necessity.
• Evaluate admissions and coordinate reviews with departments.
• Maintain knowledge of third-party payer requirements.

Skills

Communication

Clinical Assessment

Patient Care

Regulatory Compliance

Utilization Review

Education

Registered Nurse Diploma

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

Computer Skills

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Competitive salary with opportunities for bonuses
- Opportunity for career advancement and professional development
- Work in a supportive and collaborative environment focused on patient care
- Chance to make a significant impact on patient outcomes and healthcare quality
- Flexible work schedule options, including potential on-call availability

What to Expect (Job Responsibilities):
- Review medical information to ensure compliance with regulations and assess medical necessity
- Validate levels of care and evaluate admissions for appropriateness and necessity
- Coordinate and plan medical necessity reviews with relevant departments
- Maintain knowledge of third-party payer and government requirements related to medical audits
- Ensure compliance with Ochsner Health System’s standards and regulations

What is Required (Qualifications):
- Required: Registered Nurse Diploma
- Minimum of 3 years of hospital-based experience in patient care as an RN
- Experience in Case Management, Utilization Review, and/or Discharge Planning
- Current State of Louisiana Registered Nurse (RN) License
- Proficiency in computer skills and effective communication abilities

How to Stand Out (Preferred Qualifications):
- Associate's or Bachelor's degree in Nursing
- Experience in Appeal/Denial Management
- Certification in Case Management (CCM) or other relevant certifications
- Demonstrated ability to work calmly and efficiently in high-pressure situations
- Strong financial skills and understanding of healthcare reimbursement

#HealthcareServices #PatientCare #CareerOpportunity #NursingJobs #ComplianceStandards

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