Clinical Case Manager
1 week ago
We are seeking a highly skilled Clinical Case Manager to join our team at UHS. As a Clinical Case Manager, you will be responsible for analyzing clinical claim denials, drafting detailed appeal letters, and evaluating clinical level of care. Your expertise in coding regulations, including ICD-10, DRGs, and HCPCs, will be essential in this role.
Key Responsibilities- Perform DRG validation reviews in response to audits from third-party payers.
- Review audit findings letters from third-party payers to obtain a clear understanding of audited diagnosis codes and underlying payer clinical/coding rationale.
- Analyze medical records to obtain supporting clinical documentation for billed diagnosis codes.
- Communicate findings to third-party payers in detailed appeal letters to prevent downgrade payment recoveries.
- Make decisions to update DRGs or remove or add to billed diagnosis codes based on clinical reviews.
- Call third-party payers and physician offices as needed to obtain additional clinical details.
- Identify audit trends and provide feedback to management and to UHS acute care facilities.
- Adhere to all applicable laws, regulations, and guidelines.
- RN or LPN licensure in good standing is required. BSN degree preferred.
- Three to five years of experience is preferred.
- Working knowledge of coding regulations including ICD-10, DRGs, and HCPCs.
- CPC, CCS, or other coding credentials preferred, but not required.
- CDI experience is preferred.
- CCDS certification is preferred.
- Experience working in Patient Financial Services and an understanding of the Revenue Cycle from beginning to end is preferred.
- Experience working in case management or audit with technical denials is preferred.
- Strong Microsoft Office skills (Excel, Word, Outlook).
- Customer-focused both internally and externally, strong attention to detail, the ability to multi-task.
- Excellent written and oral communication skills are required.
-
Clinical Case Manager
2 weeks ago
Richmond, Virginia, United States St. Joseph's Villa Full timeJob SummarySt. Joseph's Villa seeks a skilled Clinical Case Manager to provide targeted discharge linkages for clients, ensuring ongoing stabilization for the next appropriate level of care.Key ResponsibilitiesCollaborate with the Program Director to develop and implement discharge plansProvide education and support to clients and their familiesFacilitate...
-
Travel Nurse RN Case Manager
2 weeks ago
Richmond, Virginia, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job in Richmond, Virginia.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in Richmond Virginia.TotalMed Case Management Staffing is a leading provider of...
-
Clinical Case Manager RN
4 weeks ago
Richmond, Virginia, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled RN Case Manager to join our team in the Northern Virginia area. As a Field Case Manager RN, you will be responsible for assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs and facilitate their overall wellness.Key ResponsibilitiesConduct...
-
Case Manager
4 weeks ago
Richmond, Virginia, United States LHH Recruitment Solutions Full timeJob Title: Case ManagerLHH Recruitment Solutions is seeking a skilled Case Manager to join their team in Richmond, VA. As a Case Manager, you will play a vital role in helping individuals or families navigate personal, health, and social challenges.Key Responsibilities:Provide individualized support to claimants, tailoring services to meet their unique needs...
-
Case Manager
4 weeks ago
Richmond, Virginia, United States LHH Recruitment Solutions Full timeJob Title: Case ManagerLocation: Richmond, VALHH Recruitment Solutions is partnering with an organization in the Richmond area to find a skilled Case Manager to join their team. If you're passionate about making a positive impact on the lives of children and families, especially those with disabilities, this is an exciting opportunity to contribute...
-
Clinical Case Manager
4 weeks ago
Richmond Heights, Virginia, United States UHS Full timeJob Title: DRG Nurse AuditorJoin UHS, a leading healthcare provider, as a DRG Nurse Auditor in our Atlantic Region CBO. As a key member of our team, you will be responsible for analyzing clinical claim denials, drafting detailed appeal letters, evaluating clinical level of care, and reviewing denial trends.Key Responsibilities:Perform DRG validation reviews...
-
Richmond, Virginia, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a skilled Social Work professional for a travel assignment in Richmond, Virginia.Job DetailsSpecialty: Licensed Clinical Social WorkerDiscipline: Social WorkEmployment Type: TravelWe are looking for a dedicated and experienced Social Worker to join our team for a 13-week assignment.TotalMed Case Management...
-
Case Manager
1 week ago
Richmond Heights, Virginia, United States Molina Healthcare Full timeJob Title: Case ManagerMolina Healthcare is seeking a skilled Case Manager to join our team. As a Case Manager, you will play a critical role in ensuring that our members receive high-quality, patient-centered care.Job SummaryThe Case Manager will work closely with our interdisciplinary care team to assess, facilitate, plan, and coordinate care for our...
-
Case Manager
4 weeks ago
Richmond, Virginia, United States LHH Recruitment Solutions Full timeJob SummaryLHH Recruitment Solutions is seeking a skilled Case Manager to join our team in Richmond, VA. As a Case Manager, you will play a vital role in helping individuals or families navigate personal, health, and social challenges. If you're passionate about making a difference in the lives of children and families, especially those impacted by...
-
Case Management Coordinator
2 weeks ago
Richmond, Virginia, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Case Management Coordinator to join our team. As a Case Management Coordinator, you will play a critical role in facilitating appropriate healthcare outcomes for members by providing care coordination, support, and education through the use of care management tools and resources.Key ResponsibilitiesEvaluate members'...
-
Medical Case Manager
2 months ago
Richmond, Virginia, United States Commonwealth of Virginia Full timeJob SummaryThe Commonwealth of Virginia is seeking a highly skilled Medical Case Manager to join our team at the VCU School of Medicine. As a Medical Case Manager, you will play a critical role in providing coordination, guidance, and assistance to improve access to and retention of needed medical and support services for HIV-positive clients.Key...
-
Case Management Coordinator
2 weeks ago
Richmond, Virginia, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Case Management Coordinator to join our team. As a Case Management Coordinator, you will play a critical role in facilitating appropriate healthcare outcomes for members by providing care coordination, support, and education through the use of care management tools and resources.Key ResponsibilitiesEvaluate members'...
-
Nurse Auditor
1 week ago
Richmond, Virginia, United States Universal Health Services Full timeJob SummaryWe are seeking a skilled Nurse Auditor to join our team at Universal Health Services. As a key member of our clinical case management team, you will be responsible for resolving billing edits, coordinating and completing billing audits, and educating business office and facility staff on charging and billing issues.Key ResponsibilitiesPerform...
-
RN Case Manager
1 month ago
Richmond, Virginia, United States Shaker for ChristianaCare Direct Full timeWeekend RN Case Manager Job DescriptionShaker for ChristianaCare Direct is seeking a skilled RN Case Manager to join our team. As a Weekend RN Case Manager, you will play a critical role in managing patient care and driving patient progression and establishing a discharge plan.Key Responsibilities:Identify patients with post-acute care needs and develop a...
-
Medical Case Manager
1 month ago
Richmond, Virginia, United States Commonwealth of Virginia Full timeJob SummaryThe Commonwealth of Virginia is seeking a highly skilled Medical Case Manager to join our team at the VCU School of Medicine. As a Medical Case Manager, you will play a critical role in providing coordination, guidance, and assistance to patients with HIV/AIDS, ensuring they receive the necessary medical and support services to manage their...
-
RN Case Manager Supervisor
2 months ago
Richmond, Virginia, United States Texas Department of Aging & Disability Services Full timeJob SummaryWe are seeking a highly skilled and experienced Nurse III Manager to join our team at the Texas Department of Aging & Disability Services. As a key member of our nursing leadership team, you will be responsible for overseeing the assessment, care, and integrated treatment of individuals residing at our State Supported Living Centers.Key...
-
Case Manager II
2 weeks ago
Richmond, Virginia, United States HealthSouth Full timeUnlock Your Potential as a Case Manager IIAre you a dedicated healthcare professional looking to make a meaningful impact in the lives of patients and their families? Do you possess exceptional clinical skills and a passion for delivering exceptional care? If so, we invite you to explore this exciting opportunity as a Case Manager II at Encompass...
-
Case Management Coordinator
3 weeks ago
Richmond, Virginia, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Case Management Coordinator to join our team. As a Case Management Coordinator, you will play a critical role in facilitating appropriate healthcare outcomes for members by providing care coordination, support, and education through the use of care management tools and resources.Key ResponsibilitiesConduct...
-
Nurse Case Manager
2 weeks ago
Richmond, Virginia, United States US Tech Solutions Full timeJob Title: Nurse Case ManagerAt US Tech Solutions, we are seeking a skilled Nurse Case Manager to join our team. As a key member of our healthcare management team, you will be responsible for assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs and facilitate their overall wellness.Key...
-
Case Manager
4 weeks ago
Richmond, Virginia, United States Crawford Thomas Recruiting Full timeCase Manager (Personal Injury) - Richmond, VASalary: $60K-$80K + Full Benefits!Location: Remote work, supporting the Richmond officeAbout the Company:Our client is a reputable legal firm specializing in personal injury cases. With over 200 employees, they have been a powerhouse in personal injury and car accident law since 1993, consistently winning for...