RN Utilization Specialist Denials & Appeals

Middleburg Heights, OH - USA

Monthly Salary: Not Disclosed

Posted on: 5 days ago

Vacancies: 1 Vacancy

Job Summary

Summary

POSITION INFORMATION
- Position summary:Utilization Specialist Denials & Appeals will support the clinical staff utilization specialists denials management and the Physician Advisors. This role will review patient medical records to ensure accurate documentation proper level of care and compliance with regulatory standards to prevent denials in the acute care setting.
MINIMUM QUALIFICATIONS
- Education:
  - Bachelors degree in nursing (BSN) preferred
- Required length and type of experience:
  - Minimum of three years of clinical nursing experience with strong preference for experience in case management utilization review or CDI in the acute care setting.
  - Knowledge of ICD-10 coding guidelines Medicare/Medicaid regulations MCG Cerner (EMR) MS office tools such as Word Excel PowerPoint.
  - Ability to analyze complex medical records and identify gaps in documentation.
  - Strong verbal and written communication skills to interact with physicians and insurance payers.
  - Ability to collaborate with diverse teams including nurses physicians and administrative staff.
- Required licensure certification or registry:
  - Current RN License by the Ohio State Board of Nursing.
  - Preferred certification(s): ACM/ACM-RN CCM CMAC CPHQ.

Required Experience:

Summary POSITION INFORMATIONPosition summary:Utilization Specialist Denials & Appeals will support the clinical staff utilization specialists denials management and the Physician Advisors. This role will review patient medical records to ensure accurate documentation proper level of care and compl...