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Clinical Finance Case Management - RN Specialist 2
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Job Description
- Req#: R131780
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely with a flexible schedule
- Engage in a vital role supporting the revenue cycle and clinical operations
- Collaborate with multidisciplinary teams to influence patient care and financial outcomes
- Comprehensive benefits package including healthcare coverage and retirement plans
What to Expect (Job Responsibilities):
- Implement and support the philosophy, mission, and standards of the employer in the role of Clinical Financial Case Manager
- Secure complex pre-authorizations and prevent/appeal clinical denials using clinical knowledge
- Interpret medical necessity guidelines to determine appropriateness for services provided
- Maintain awareness of healthcare trends and payer requirements to ensure compliance and efficiency
- Collaborate with various departments to resolve complex billing scenarios and support utilization management
What is Required (Qualifications):
- Bachelor's degree in nursing with a current license
- Minimum of 3 years of clinical care experience
- Experience collaborating with physicians and their designees
- Strong analytical skills and ability to make educated decisions
- Proficiency in Microsoft Office products and various technology applications
How to Stand Out (Preferred Qualifications):
- Experience with Managed Care, Revenue Management, and Clinical Documentation Improvement
- Knowledge of denial/remark codes and reimbursement processes
#HealthcareServices #ClinicalManagement #RemoteWork #CareerOpportunity #RevenueCycle
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