Clinical Financial Case Management, RN Specialist 2
The Ohio State University, Main Campus
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center
- Functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials
- Utilizes clinical knowledge to interpret and apply medical necessity guidelines
- Makes determinations on the appropriate level of care
- Maintains awareness of State and National Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines
- Must be able to read, understand and interpret a payer remit, denial/remark codes, and expected reimbursement to determine the cost effectiveness of completing an appeal
- Must be versatile, flexible, and very adaptable to change
Requirements
- Bachelor’s degree in nursing with current license required
- Minimum of 3 years clinical care experience, caring for patients, anticipating their needs, and understanding the physician’s plan of care
- Experience collaborating with physicians and their designees
- Strong, proven analytical skills
- Extensive knowledge of clinical operations and patient flow
- Skilled at synthesizing large volumes of information and concisely communicating either verbally or in writing
- Proficient in Microsoft Office Products such as: Word, Power Point, Excel, SharePoint, Teams, OneNote, etc.
- Proficient in Adobe Professional
- Proficient in using email, fax machines, copy machines, internet browsers
- Proficient at typing
- Proficient in Technology, Computer, and Web applications
Benefits
- Medical, dental and vision insurance
- Tuition assistance for employees and their dependents
- State or alternative retirement options with competitive employer contributions
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical care experienceanalytical skillsclinical operations knowledgemedical necessity guidelines interpretationpayer remit interpretationdenial/remark codes understandingcost effectiveness analysistyping proficiency
Soft Skills
collaborationcommunication skillsadaptabilityflexibility
Certifications
Bachelor’s degree in nursingcurrent nursing license