UR/TOC & Denials RN

Job Summary

• Clinical Analysis, Data Management and Denial prevention
• Responsible for compiling an appropriate appeal response to commercial and/or government appeal response to commercial and/or government payer regarding denial and/or audit, including follow up of appeals throughout process for resolution and reporting.
• Utilization Review, Utilization Management, Advocacy and Education
• Responsible for review of concurrent denial/reimbursement from commercial and/or government payers for inpatient and outpatient.

Qualifications

Education

• Bachelor of Science in Nursing (BSN) or Masters of Science in Nursing (MSN) preferred, Associate degree of Nursing (A.D.N.) required.

Experience

• Minimum of three years of experience in acute care patient setting.
• Minimum of one year experience in Clinical Documentation or Appeal/Denial Management experience preferred.
• Utilization Review or Case Management experience preferred.

Licensure/Certification/Registration/ETC.

• Current OK RN license required. Basic Life Support (BLS) training or retraining is required and must be maintained for the duration of employment.

Compensation/Benefits

• $30.10-$49.17/hr depending on previous work experience.
• Benefits include medical, dental, vision, short-term disability, long-term disability, life insurance, paid time off (PTO), paid holidays, tuition reimbursement, scholarship opportunities, retirement plans, free parking, and opportunities for advancement.

Work Shift

Day Position Type

Regular Full Time

• Clinical Analysis, Data Management and Denial prevention
• Responsible for compiling an appropriate appeal response to commercial and/or government appeal response to commercial and/or government payer regarding denial and/or audit, including follow up of appeals throughout process for resolution and reporting.
• Utilization Review, Utilization Management, Advocacy and Education
• Responsible for review of concurrent denial/reimbursement from commercial and/or government payers for inpatient and outpatient.

Education

• Bachelor of Science in Nursing (BSN) or Masters of Science in Nursing (MSN) preferred, Associate degree of Nursing (A.D.N.) required.

Experience

• Minimum of three years of experience in acute care patient setting.
• Minimum of one year experience in Clinical Documentation or Appeal/Denial Management experience preferred.
• Utilization Review or Case Management experience preferred.

Licensure/Certification/Registration/ETC.

• Current OK RN license required. Basic Life Support (BLS) training or retraining is required and must be maintained for the duration of employment.

Compensation/Benefits

• $30.10-$49.17/hr depending on previous work experience.
• Benefits include medical, dental, vision, short-term disability, long-term disability, life insurance, paid time off (PTO), paid holidays, tuition reimbursement, scholarship opportunities, retirement plans, free parking, and opportunities for advancement.