RN Denials/Appeals Case Manager

POSITION SUMMARY:

To assist with coordination of utilization review and denials and appeal management functions.

EDUCATION:

Graduate from an accredited School of Nursing. Current/valid State of New Jersey license (or legal permission to work from the New Jersey Board of Nursing). Completion of general nursing orientation, CPR certification and unit based orientation. BSN.

EXPERIENCE:
Minimum of five years in Utilization Review, Quality Improvement and/or Case Management. Computer and keyboard skills. Medical terminology required. Medicare, Medicaid, and Commercial Insurance policies and procedures.

SPECIAL SKILLS:
Physical and cognitive requirements: Position's physical requirements necessitate a full range of body motion including but not limited to, physically assisting patients, requiring stretching, bending, lifting, sitting, kneeling, stooping, standing, walking, pushing and pulling. Position is classified according to the USDOL as Very Heavy Work which is defined as exerting in excess of 100 pounds of force occasionally, and/or in excess of 50 pounds of force frequently, and/or in excess of 20 pounds of force constantly to move objects. The National Institute of Safety and Health (NIOSH0 guidelines, which recommends that the average worker not lift more than 51 pounds without assistance, will be followed. Manual and finger dexterity and hand-eye coordination are also required as is constant talking and listening in English except when interacting with patients/ patient family members in their native language. Must demonstrate effective oral and written communication skills, including speech clarity, understanding the information relayed, deductive and inductive reasoning skills (the ability to apply general rules to specific problems to produce answers that make sense and the ability to combine pieces of information to/from general rules or conclusion respectively). Considerable walking, standing, sitting, reaching, filing, typing and photocopying required. Ability to perform work accurately and pay attention to details, often changing from one task to another without loss of efficiency or composure. Ability to function competently in stressful situations and changing work environment related to changing needs of patients with acute, chronic and complex and/or terminal disease processes. Ability to work cooperatively within health system, multidisciplinary team members (i.e. MD's, Rehab, Respiratory, DI, Laboratory, etc). Ability to utilize effective time management skills to set priorities to perform responsibilities, problem solve and deliver care.

Area of Talent: Nursing

Organization: The Valley Hospital

Department: VH CARE COORDINATION

Shift: Day

Full Time

Schedule: 7:30 am - 4:00 pm

req14964

United States