Clinical Financial Case Manager – RN, Escalation Lead

The Ohio State University, Main Campus

Clinical Financial Case Manager - RN providing advanced clinical appeal services at The Ohio State University. Responsible for reviewing and escalating complex patient account denials while ensuring regulatory compliance.

Posted 6/2/2026full-timeRemote • 🇺🇸 United StatesSeniorWebsite

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Hard Skills

clinical reviewpayer policy interpretationregulatory compliancedenial prevention strategiesquality assuranceworkflow evaluationcase resolutiondata analysisperformance monitoring

Soft Skills

collaborationcoachingprocess improvementcommunicationleadership

Certifications & Qualifications

Registered NurseBachelor's degree

Industry Keywords

clinical appealspayer contractual termscommercial payergovernmental payerdenial trendstechnology-enabled workflows

About the role

Key responsibilities & impact

Provides advanced clinical appeal services with a focused responsibility for review and escalation of complex patient account denials.
Independently performs complex clinical reviews and evaluates relevant payer contractual terms and payer policies/guidelines to determine need for and method of escalation.
Monitors and reports on commercial and governmental payer denial trends and assists in the development of denial prevention strategies.
Assists the Manager as clinical and operational resource for the clinical appeals team, supporting complex case resolution, payer policy interpretation, regulatory compliance, and technology-enabled workflows.
Monitors payer and regulatory updates, disseminating this information with the team.
Assists the Manager in evaluating workflows for effectiveness, and in supporting the adoption of new tools and systems.
Oversees quality of clinical appeals and provides actionable quality assurance insights to management.
Assists the Manager in monitoring productivity and performance trends.
Aligns team operations with departmental goals, payer requirements, financial performance, and organizational technology initiatives through collaboration, coaching, and process improvement.

Requirements

What you’ll need

Bachelor's degree or equivalent experience.
Registered Nurse.
2 years of relevant experience required.
2-4 years of relevant experience preferred.

Benefits

Comp & perks

Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost.
Paid time off, including sick and vacation time and 11 holidays.
State retirement plan or an alternative retirement plan, both with generous employer contributions.