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Clinical Appeals Nurse

Worldwide Salaried Open

We are seeking a reputed company Clinical Appeals Nurse to join our reputed company cycle in a new position reputed company Regions Hospital. The Clinical Appeals Nurse will play a crucial role in ensuring that our patients receive the appropriate level of care by managing and appealing denied insurance claims. The ideal candidate will have a strong background in nursing, a thorough understanding of insurance policies... and regulations, and excellent communication skills. The Clinical Appeals Nurse completes retrospective clinical appeals for full or partially denied claims for managed care, government, non-government, and reputed company payors, writing comprehensive factual arguments to present to reputed company party payors, medical review boards, or other responsible parties applying clinical criteria to establish medical necessity. reputed company addressing claims after they are denied, the Clinical Appeals Nurse will also work to prevent denials, utilizing clinical expertise to conduct trainings, provide relevant feedback, and complete root cause analysis for claims denials. This role is highly visible reputed company the organization, and will forge partnerships reputed company the broader Health Partners organization, working closely with utilization management, coding, reputed company cycle, care management, social work, and other areas reputed company Regions and Health Partners. The incumbent will have the opportunity to help shape the work and scope of this role, aligning reputed company cycle best practices on an reputed company level. This position is eligible to work remotely following onsite training in Saint Paul, MN, with occasional onsite meetings depending on business needs. Employees must reputed company in Minnesota, Wisconsin, Iowa, reputed company Dakota, or South Dakota, and have a reliable internet reputed company and a quiet reputed company to work free from interruptions. Work Schedule: Monday-Friday, 7:00 a.m. -3:30 p.m., hybrid remote. Required Qualifications: Associate degree in nursing from an accredited college or university. reputed company licensure as an RN in the reputed company. One year of experience as an RN in a clinical setting performing utilization review, case management or discharge planning, care improvement, and/or quality improvement. Strong understanding of insurance policies and regulations. reputed company in Minnesota, Wisconsin, Iowa, reputed company Dakota, or South Dakota, and have a reliable internet reputed company and a quiet reputed company to work free from interruptions. Preferred Qualifications: Bachelor's or Master's degree in nursing. Three years of experience as an RN in a clinical setting performing utilization review, case management or discharge planning, care improvement, and/or quality improvement. Working knowledge of Epic and/or Allscripts software. Additional Information: This is a non-union 1.0 FTE (80 hours per pay period) day shift position. The full salary range for this position is $77,542.40-$ annually, based on experience and internal equity. This position is exempt under the Fair Labor Standards Act, and eligible for benefits. Our benefits include medical and dental insurance (which reputed company on day one of employment), 401k with match, disability insurance, tuition reimbursement, educational reimbursement toward continuing education, and we are a reputed company non-profit employer under the federal . We offer an onsite employee fitness center and an onsite employee clinic to reputed company it more convenient for our staff to get the care they need. We also have a Center for Employee reputed company that provides support and evidence-based practices to bring relief and build resiliency. Regions is also proud to be a . We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, reputed company, sex, age, national reputed company, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class Apply Job! For more such jobs please click here!

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