Registered Nurse RN - Utilization Management Denials & Appeals

Company: WellStar Health System
Location: Marietta
Posted on: February 16, 2019

Job Description:

Overview
At WellStar we all share common goals. That s what makes us so successful and such an integral part of our communities. We want the same things, for our organization, for our patients, andfor our colleagues. As the largest not-for-profit healthcare system in Georgia, this means we pride ourselves on investing in the communities that we serve. We continue to provide innovative care models, focused on improving quality and access to healthcare.

Responsibilities
WellStar is looking to add a Registered Nurse (RN), Utilization Management Denials & Appeals to its team!!

The Clinical Appeals Process focuses on the review and analysis of medical necessity and authorization payer denials rationales and provides appropriate medical necessity appeal services. The Appeals Nurse will review all denial rationales and case-specific medical records for compliance, accuracy and completeness in accordance with departmental policies and regulations, medical necessity criteria set, payer regulations and other contractual requirements. The appeal nurse will work in conjunction with the UM medical director in constructing appeal letters as appropriate.

Qualifications
Required Minimum Education:

• At least a 2-year degree in nursing required. Bachelor s or above preferred Required Minimum Certification:
  • Must possess a current nursing license (RN) in state of GA. Required Minimum Experience:
    • Minimum of 3 years of experience as a case manager, discharge planner, utilization review nurse required.
    • Minimum of three years of experience as a staff nurse in an acute care setting. Required Minimum Skills:
      • Proficient in typing
      • Experience with Microsoft Office suite
      • Ability to learn and understand various clinical software applications
      • Strong clinical judgment and multitasking ability
      • Excellent problem-solving skills
      • Self-motivation and ability of working independently with limited supervision and structure
      • Excellent interpersonal, verbal, and written communication skills Join us for outstanding benefits and development opportunities. We also offer state-of-the-art technology, professional support and advancement, and colleagues that rank amongst the best in the country.
        
        Step up to your potential. Find out more and apply today!
        
        Associated topics: ambulatory, care, coronary, neonatal, nurse rn, psychatric, psychiatric, registed, surgical, tcu

        Keywords: WellStar Health System, Atlanta , Registered Nurse RN - Utilization Management Denials & Appeals, Healthcare , Marietta, Georgia

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