Rn Case Mgt Compliance- Case Management- Ft- 1St Shift

Overview

The Denial and Appeals Case Manager is responsible for overall management of clinical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Where warranted, the Clinical Appeals specialist will write sound, compelling factual arguments to support the hospital stay. This individual is a liaison and point of contact to/for outside payers for denial and appeal inquiries. Coordinates Blue Cross of AL Compliance functions for the department to assure achievement of target score and avoidance of denials.

Qualifications

Education :

Graduate of accredited School of Nursing with current Alabama licensure. Bachelor’s Degree in Nursing or an equivalent in a related discipline required. Knowledge in Level of Care criteria as well as knowledge of third party payer regulations related to utilization and quality is also preferred.

Experience : Minimum of two years experience in Case Management Utilization Review.

Additional skills/Abilities : Proficiency in use of computers including organization computer system. Knowledge of medical terminology. Excellent communication skills, verbal and written. Demonstrated organizational skills including ability to work in a fast paced environment. Ability to work independently.

About Us

Highlights of our hospitals

Huntsville Hospital was recently named Best Regional Hospital and #2 in Alabama by U.S. News & World Report . With 971 beds, a specialized Orthopedic & Spine Tower, a Level III Regional Neonatal ICU, and the largest Emergency Department and Level 1 Trauma Center in the state with our own specialized Red Shirt Trauma Program, there are many opportunities to apply your knowledge and skills. We are a certified Primary Stroke Center and named "One of the Top 100 Hospitals in the Nation with Great Heart Programs." From six cath labs and four EP labs to multiple medical and step-down units, you can continually grow your skillset! We offer a training center on campus for continuing education, Shared Governance Program, Clinical Ladder for professional development, The Daisy Award, and if you are a new grad, a Nurse Residency Program to help you transition from student to professional nurse. We care about you and your well-being by offering an excellent benefits package, childcare, health and wellness programs, an onsite employee pharmacy, a free health clinic, tuition assistance, and much more. We are committed to creating a diverse environment and proud to be an equal opportunity employer. Ask us about incentives and additional opportunities.

Huntsville Hospital Benefits

We are committed to providing competitive benefits. Our benefits package for eligible employees includes medical, dental, vision, life insurance, flexible spending; short term and long term disability; several retirement account options with 401K organization match; nurse residency program; tuition assistance; student loan reimbursement; On-site training and education opportunities; Employee Discounts to phone providers, local restaurants, tickets to shows, apartment application and much more!

Learn More About Huntsville Hospital Health System

• Life In Huntsville : https://www.huntsvillehospital.org/about-huntsville-al
• Education & Professional Development : https://www.huntsvillehospital.org/education
• Benefits : https://careers.hhsys.org/careers-home#benefits
• Careers : https://careers.hhsys.org/careers-home