RN-UR Appeals Nurse

3 weeks ago


Halethorpe, Maryland, United States Ascension Full time
Job Summary

We are seeking a skilled RN-UR Appeals Nurse to join our team at Ascension Saint Agnes in Baltimore, Maryland. As an Appeals Nurse, you will play a critical role in reviewing admissions and service requests for medical necessity and compliance with reimbursement policy criteria.

Responsibilities
  • Review admission and service requests for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
  • Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • Prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third-party payer utilization management rules and regulations.
Requirements
  • Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.
  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Preferred Qualifications
  • Maryland RN license is required.
  • Seeking experienced Appeals Review nurse.
  • Will consider training a nurse with previous Utilization Review experience.
About Ascension

Ascension Saint Agnes is a full-service, 254-bed teaching hospital in Baltimore, Maryland. As an associate, you will be part of a team committed to providing a place of respect and inclusion for all associates, as well as a rich learning environment with countless opportunities for career growth and professional development.

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision, and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer, and make a positive impact in their community.


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