Travel RN - Case Management​/Utilization Review - Case Management

American Traveler is hiring an experienced RN for a Clinical Denials Specialist (Case Manager) position requiring Epic proficiency, clinical appeal letter writing experience, and a FL or Compact RN license.

Job Details

• Hospital-based Case Management/Utilization Review setting within a Revenue Cycle environment,

• Primary focus on clinical denial management, including reviewing denied accounts and submitting clinical appeals,

• Day shift, 5x8-hour shifts (8:00 AM - 5:00 PM),

• Epic EMR used; experience required,

• No telemetry or bedside patient care responsibilities - this is a desk-based denials and appeals role,

Job Requirements

• Active FL or Compact RN license currently in hand,

• Current BLS (AHA or ARC) and ACLS required; NIH Stroke Scale certification also required,

• Minimum of 2 years of recent, consecutive clinical or case management experience within the past 24 months in a US hospital,

• Degree from an accredited nursing school, or from an institution approved by the Florida Board of Nursing (FBON) with 2 years of recent acute care experience,

• Clinical appeal letter writing experience required,

• Epic EMR experience required, with demonstrated expertise in Revenue Cycle,

• Case management experience highly preferred,

Additional Information

• Responsible for conducting comprehensive reviews of denied accounts, writing compelling clinical appeal letters, and submitting appeals to payers in a timely manner,

• Manages a work queue of accounts receivable and sets follow-up activities based on claim status,

• Researches payer denials related to referrals, eligibility, pre-authorization, non-covered expenses, and billing issues,

• Remains current on CMS guidelines, payer-specific policies, contracts, and administrative bulletins,

• Communicates identified payer denial trends to relevant stakeholders,

• Smoke-free facility,

• COVID vaccination documentation required - declinations are not accepted,

• Local candidates residing within a 60-mile radius of the facility are eligible to apply