Clinical Financial Case Management - RN Specialist

Employer Industry: Healthcare Services

• Opportunity for career advancement and growth within the organization
• Work remotely from any location
• Supportive and collaborative work environment
• Engage in meaningful work that impacts patient care and revenue cycle management
• Strong focus on continuous learning and professional development

• Implement and support the mission and policies of the employer while managing clinical financial case management
• Secure complex pre-authorizations and prevent or appeal clinical denials using clinical knowledge
• Interpret medical necessity guidelines and determine appropriate levels of care
• Become a Subject Matter Expert (SME) for assigned payers and governmental payer requirements
• Collaborate with various departments, including Legal, Medical Information Management, and Physician groups

• Bachelor’s degree in nursing with a current license
• Minimum of 3 years of clinical care experience
• Proven experience in collaborating with physicians and their designees
• Strong analytical skills with the ability to make educated decisions
• Proficiency in Microsoft Office products and technology applications

• Experience in revenue cycle management or clinical documentation improvement
• Familiarity with payer remits, denial codes, and appeals processes
• Advanced skills in synthesizing large volumes of information for effective communication
• Knowledge of compliance and legal aspects within healthcare settings

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