Integrated Nurse Case Manager, Registered Nurse (RN) – Inpatient and Outpatient Clinical Appeals

Role Overview

• Manage inpatient and outpatient provider appeals across all payer types, including government and commercial insurance
• Review clinical denials (non-billing related), identify root causes, and perform post-claim analysis to support appeal submissions

Requirements

• 3 years experience in Nursing REQUIRED
• RN-Diploma (Non-degree) REQUIRED; Bachelors Degree in Nursing preferred
• Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management preferred
• Provider appeals experience is a plus
• Strong proficiency in Excel

Benefits

• Medical, Dental, Vision 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 Guild 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 met