DENIALS MANAGEMENT RN

4 weeks ago

Omaha NE USA, United States Catholic Health Initiatives Full time
**Overview**

The Denials RN is responsible and accountable for receiving, processing and documenting all concurrent denials for assigned facilities. The RN has an integral role within the revenue cycle by providing clinical expertise in the denials management process.

The Denials RN performs a root cause analysis of the concurrent denial, formulates and implements a plan for addressing the specific root cause for that denial, identifies gaps in processes that lead to concurrent denials, documents and communicates findings to management. Recommends and provides education in collaboration with their manager.

The Denials RN follows a standardized approach to managing denials in order to achieve the organizational objectives of financial stewardship and patient advocacy through accurate billing.

Incumbents will use professional judgment, independent analysis and critical-thinking skills to apply clinical guidelines, policies, and payer knowledge to ensure the best possible financial outcome.

The Denials RN is accountable for demonstrating a strong commitment to promoting quality every day by demonstrating our organizational values of: Compassion, Inclusion, Integrity, Excellence, and Collaboration.

**Responsibilities**

1. Determines appropriate admit status for concurrently denied hospital stays, using utilization management guidelines, medical necessity criteria, critical thinking skills, and physician advisor review.

2. Identifies denial root cause for each individual concurrent denial.

3. Determines appropriate denial resolution strategy based on individual payer policies.

4. Implements strategies, such as RN reconsideration and peer to peer physician review.

5. Escalates challenging cases and concerning payer trends to Leadership.

6. Documents findings and determinations in electronic medical record or denial software.

7. Collects denial metrics and data for the generation of facility and payer specific denial reports.

8. Oversees collection and utilization of operational and benchmarking data to identify gaps in process, recommend and set targets for improvements; and recommends process improvements to leadership.

9. Collaborates with various internal departments to gather critical information and to share denial trends and gaps in process.

10. Performs Medicare short stay reviews and validation as assigned.

11. Develops, reviews, and recommends policies which support the direction of denial prevention activities.

12. Facilitates orientation and onboarding of new staff by acting as a preceptor of newly hired denial RNs.

13. Performs other duties as assigned by the manager.

**Qualifications**

**Required:**

+ Minimumthree (3)yearsclinical experience as Registered Nurse (RN) required.

+ RN license

+ BLS required within 3 months of hiring if located within hospital

**Preferred:**

+ Graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field.

+ 5 years of RN experience preferred.

+ Minimum Three (3) years utilization management experience preferred

+ Denials management experience preferred.

+ Care Management certification (CCM or ACM) preferred

**Pay Range**

$30.39 - $44.06 /hour

We are an equal opportunity/affirmative action employer.

  • Utilization Review RN

    2 months ago

    Omaha, United States CHI Health Full time

    Overview Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the...

  • Travel-RN-Management

    1 week ago

    Omaha, NE, United States Vivian Health Full time

    Vivian is looking for Travel Case Management RNs in Omaha, Nebraska paying up to $2,360/week At Vivian, we ensure your next step is a step forward. That's why we built a jobs marketplace that serves healthcare professionals first. It's easy to get started:  # Create a profile - Build your reputation with a universal profile that works across hundreds of...

  • Travel Registered Nurse RN Care Management

    1 week ago

    Omaha, NE, United States MedPro Healthcare Staffing Full time

    MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Specialty: Case Management ~ Shift: 8 hours, days ~ Employment Type: Travel MedPro Healthcare Staffing , a Joint Commission-certified staffing agency, is seeking a quality Case Manager Registered Nurse (RN) for a travel assignment...

  • Travel Registered Nurse RN Care Management

    1 week ago

    Omaha, NE, United States Advantis Medical Full time

    Advantis Medical is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements ~ Specialty: Case Management ~ Discipline: RN ~ Start Date: 06/10/2024 ~ Duration: 13 weeks ~40 hours per week ~ Shift: 8 hours, days ~ Employment Type: Travel Advantis Medical, the #1 rated travel nurse...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States MedPro Healthcare Staffing Full time

    MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/06/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel MedPro Healthcare Staffing , a Joint...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States Genie Healthcare Full time

    Genie Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/24/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel BLS, CHI Health Workplace Violence Prevention,BLS and...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States ADEX Healthcare Staffing LLC Full time

    ADEX Healthcare Staffing LLC is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Travel or local RN needed for ASAP start. Min 2+ years recent hospital...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States Advantis Medical Full time

    Advantis Medical is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/10/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Advantis Medical, the #1 rated travel nurse agency, is currently...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States PHP Full time

    PHP is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 07/22/2024 Duration: 13 weeks 40 hours per week Shift: 12 hours, days Employment Type: Travel Perks: Benefits included: Medical, Dental & Vision, 401K, and GH. Benefits...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States PHP Full time

    PHP is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/24/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Perks: Benefits included: Medical, Dental & Vision, 401K, and GH. Benefits...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States Advantis Medical Full time

    Advantis Medical is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/10/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Advantis Job ID #606599. Pay package is based on 8 hour shifts...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States Summit Medical Staffing Nursing Full time

    Summit Medical Staffing Nursing is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 07/22/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Must have MCM experience, EPIC, 50 mile radius...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States Summit Medical Staffing Nursing Full time

    Summit Medical Staffing Nursing is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/24/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel *Certifications Required: BLS and de-escalation...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States PHP Full time

    PHP is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/24/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Perks: "Perks: PHP Benefits includes Day 1 - Medical, Dental & Vision....

  • Travel Nurse RN

    7 days ago

    Omaha, NE, United States OneStaff Medical Full time

    OneStaff Medical is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: ASAP Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Case Management Nurses coordinate long-term care for their patients....

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States OneStaff Medical Full time

    OneStaff Medical is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: ASAP Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Case Management Nurses coordinate long-term care for their patients....

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States IDR Healthcare Full time

    IDR Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 07/22/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel ID: 335118 About IDR Healthcare IDR Healthcare is an awarding...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States Anders Group Full time

    Anders Group is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 06/24/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Anders Group Job ID #756846. Pay package is based on 8 hour shifts...

  • Travel Nurse RN

    1 week ago

    Omaha, NE, United States Vivian Health Full time

    Vivian is looking for Travel Case Management RNs in Omaha, Nebraska paying up to $2,360/week At Vivian, we ensure your next step is a step forward. That's why we built a jobs marketplace that serves healthcare professionals first. It's easy to get started:  Create a profile - Build your reputation with a universal profile that works across...

  • Staff RN

    1 week ago

    Omaha, NE, United States ADEX Healthcare Staffing LLC Full time

    ADEX Healthcare Staffing LLC is seeking a travel nurse RN Case Management for a travel nursing job in Omaha, Nebraska. Specialty: Case Management ~ Shift: 8 hours, days ~ Employment Type: Travel Travel or local RN needed for ASAP start. Min 2+ years recent hospital experience required. ADEX Healthcare Staffing LLC Job ID #710290. Pay package is...