Employer Industry: Healthcare Services

Why consider this job opportunity:
- Salary up to $157,289
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and financial outcomes
- Involvement in community outreach efforts and educational initiatives
- Opportunity to work with a diverse healthcare team

What to Expect (Job Responsibilities):
- Coordinate and monitor the denial management and appeals process to reduce financial risk
- Complete evaluations of external denials for medical necessity and decide on appeal feasibility
- Develop medical summaries for denied cases for administrative review and potential legal action
- Identify strategies to avoid denials and improve care delivery efficiency
- Maintain records of denial activity and report data to the Director and Operations Review Committee

What is Required (Qualifications):
- Associate's degree in Nursing required; Bachelor's degree in Nursing preferred
- Minimum of 2-3 years of clinical experience required
- Minimum of 2-3 years of utilization review experience in a healthcare setting preferred
- RN - Registered Nurse licensure in the District of Columbia or Maryland required
- Certification in Utilization Review, case management, and healthcare quality preferred

How to Stand Out (Preferred Qualifications):
- 1-2 years of experience in hospital audits preferred
- Attendance at yearly seminars on maternal fetal medicine (MFM) coding and billing preferred
- Strong persuasive writing skills
- Proficiency in Office Suite software applications

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