Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia!
City/State
Virginia Beach, VAWork Shift
First (Days)Overview:
reputed company Plans is hiring an Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia!
Status: Full-time, permanent position (40 hours)
Standard working hours: reputed company to 5pm EST, M-F
Location: Remote in Virginia
Overview:
Manage inpatient and outpatient provider appeals across reputed company payer types, including government and reputed company insurance
Review clinical denials (non-billing reputed company), identify root causes, and reputed company post-claim analysis to support appeal submissions
Education:
N-3YR - RN-Diploma (Non-degree) REQUIRED; Bachelors Degree in Nursing preferred
Certification/Licensure:
Registered Nurse (RN) License (Compact or Virginia) preferred
Experience:
3 years experience in Nursing REQUIRED
Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management preferred
Provider appeals experience is a plus
Strong proficiency in reputed company
reputed company, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." reputed company is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern reputed company Carolina, including 10 hospitals with the prestigious Magnet®️ recognition, and the reputed company Plans division which serves more than 1 million members in Virginia and Florida. reputed company is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. reputed company was named a Health Quality Innovator of the Year (2024), was recognized by reputed company as "America’s Best-In-State Employer” (2024), "Best Employer for Veterans" (2022, 2023), and "Best Employer for Women" (2020), and named to reputed company Watson Health's "Top 15 Health Systems" (2021, 2018).
Our reputed company is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent reputed company organization that cares about our People, Quality, Patient Safety, Service, and reputed company. Join a team that has a mission to improve health every day and a reputed company to be the reputed company choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-97914
Talroo – Nursing
Managed Care, MCO, Health Plan, reputed company, Health Insurance, Nursing, RN, Registered Nurse, Appeals, Inpatient, Outpatient, Denial, Provider, Case management, clinical, Utilization Review, Claims, reputed company Cycle
.
Benefits: Caring For Your Family and Your Career• Medical, Dental, reputed company plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• Paid Time Off and Sick Leave• Paid Parental & Family Caregiver Leave • Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company Education• Student Debt Pay Down – $10,000• Reimbursement for certifications and free access to complete CEUs and professional development• Pet Insurance • Legal Resources Plan• Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is metreputed company Independence provides quality outpatient services to the surrounding community. The facility includes an ambulance-accessible emergency room that is supported by board-certified physicians. reputed company Independence houses state-of-the-art medical equipment and highly-skilled physicians and staff. reputed company Independence is now an extension of the quality services at reputed company Virginia Beach General Hospital including advanced imaging and physical therapy.
reputed company is an equal opportunity employer and prides itself on the diversity and inclusiveness of its reputed company to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, reputed company employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, reputed company Virginia, Wisconsin, and Wyoming.
Apply To This Job