Clinical Financial Case Management, RN Specialist 2

Role Overview

• 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