Hospital Denials & Appeals RN

Location: Baltimore, MD
Date Posted: 11-01-2018
Denials & Appeals RN – Hospital System
Baltimore, MD
Job Type:  Contract, Full Time
About the Job:

CareNational, a leading medical staffing organization, is currently looking for a Denials & Appeals RN for a highly reputable health system in Baltimore, MD.  This is a Full-Time, Benefits Available, CONTRACT assignment, expected to last around 6 months, or longer! You’ll be responsible for denials, appeals, and grievances, and related activities, objectives, and analysis,  through advanced and complicated case review of the appropriateness of medical care.
Denials & Appeals RN Duties & Responsibilities:
  • The Denials & Appeals Nurse performs specific aspects of the Utilization and Quality Management Programs, including denials, appeals, and grievances, and related activities, objectives, and analysis.
  • The nurse supports the organization by working to resolve payment disputes through advanced and complicated case review of the appropriateness of medical care requiring considerable clinical judgment, independent analysis, and detailed knowledge of managed care and organizational guidelines. 
  • Responsible for oversight and execution of the grievance and appeals process, which includes coordinating the investigation among departments, analysis of root causes, collaborating with staff to develop corrective action plans, and monitoring corrective action taken.
  • Manages the consolidation of the denials, complaints, and grievance activities on a quarterly basis, and prepares monthly, quarterly and annual reports on assigned quality improvement activities.
  • This position requires a high level of critical thinking and analysis abilities.
Denials & Appeals RN Background:
  • Current, valid, and unrestricted state Registered Nurse (R.N.) license.
  • Bachelor’s of Science in Nursing (B.S.N.) is preferred.
  • Certified Professional in Healthcare Quality (CPHQ) or similar certification is a plus.
  • Roughly 2-5 years acute care clinical nursing experience is required.
  • At least 2-3 years previous experience in Denials & Grievances & Appeals and Utilization Review in a hospital setting.
  • Direct experience with hospital inpatient/outpatient coding and/or Clinical Documentation Improvement (CDI) practices is preferred.
  • Direct experience with guidelines for Medicaid/Medicare and related state programs is required.
  • Must have strong skills in medical assessment / medical record review; knowledge of coding a plus.
  • Experience using Milliman or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
  • Excellent verbal (customer service) and written (business letter writing) communication skills, as well as exceptional critical thinking skills.
Denials & Appeals RN Benefits: 

Contract workers through CareNational have the option to gain a comprehensive benefits plans that include Medical, Dental, and Vision, and more! 
We are an equal opportunity employer and value diversity in our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

443.552.7423 (CALL – TEXT – FAX)
Schedule a time to talk by clicking HERE

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