Description
**It's more than a career, it's a calling**
MO-REMOTE
**Worker Type:**
Regular
**Job Highlights:**
**Department:** Care Coordination?
**Schedule:** Full Time, Day Shift, 8:00am-4:30pm; No Weekends
**Starting Pay:** $67,766.40+ **(Offers are based on years of experience and** **equity for this role.** **)** ?
**Location:** Remote
**Candidate must live in IL, MO, OK, or WI. If living in MO, OK, or WI, must have multistate licensure. If living in IL, must have single state licensures for all four states (IL, MO, OK, and WI).
*****Prior medical denials and/or appeals management is preferred.*****
**Job Summary:**
Reviews, assesses and completes denial management activities.
**Job Responsibilities and Requirements:**
PRIMARY RESPONSIBILITIES
Screens denials for possible reconsideration, peer to peer, or formal appeal.
Collaborates with utilization management staff regarding possible reconsideration with payor.
Collaborates with physician (advisor, attending, consultant regarding peer to peer and appeal).
Monitors results of denial management activities. Identifies trends and escalates to appropriate individuals.
Active participant with other members of team regarding opportunities for improvement in standard work.
May educate case management staff and other departments regarding payer changes and denial/appeal process.
Works in a constant state of alertness and safe manner.
Performs other duties as assigned.
EDUCATION
Graduate of accredited school of nursing or education equivalency for licensing
EXPERIENCE
Three years hospital acute care registered nurse experience, with one year experience in utilization review and/or case management
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
State of Work Location: Illinois
Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
State of Work Location: Missouri
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Missouri Division of Professional Registration
State of Work Location: Oklahoma
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
State of Work Location: Wisconsin
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services
**Work Shift:**
Day Shift (United States of America)
**Job Type:**
Employee
**Department:**
Sys Utilization Management
**Scheduled Weekly Hours:**
40
-SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,- -pregnancy, veteran status- **-,-** -or any other characteristic protected by applicable law.- Click here to learn more. ()
Compensation Information:
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