RN Case Manager

6 days ago


Santa Ana, California, United States VirtualVocations Full time

VirtualVocations is seeking a skilled RN to join our team as an Appeals and Denials RN. As a key member of our team, you will be responsible for reviewing denials for possible reconsideration, collaborating with utilization management staff, and monitoring results of denial management activities.

**Key Responsibilities:**

* Screen denials for possible reconsideration, peer to peer, or formal appeal
* Collaborate with utilization management staff regarding possible reconsideration with payor
* Monitor results of denial management activities, identify trends, and escalate to appropriate individuals

**Required Qualifications:**

* Graduate of accredited school of nursing or education equivalency for licensing
* Three years hospital acute care registered nurse experience, with one year experience in utilization review and/or case management
* Professional License as a Registered Nurse in the state of work location
* Physical ability to lift/carry objects, perform various movements, and use vision and hearing effectively
* Day shift availability and 40 scheduled weekly hours


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