Senior Clinical Appeals RN - New Hyde Park, NY - Full-time / Part-time

If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
 
Primary Responsibilities:


Coordinates appeals process
Sorts, reviews and evaluates cases denied by all payers and determines follow through for first, second and third level appeals within contractual or appropriate timeframes
Monitors inpatient denials and assists patients and physicians with management of the appeals process
Writes first, second and third level insurance appeal letters
Reviews and coordinates utilization issues concurrently and retrospectively related to denials from all payors
Maintains data tracking systems and identifies Utilization trends
Serves as a resource to all hospital staff related to Utilization Management issues
Promotes staff development and education
Assesses and monitors of quality issues, and follows-up with Quality Management
3+ years of recent clinical experience
Attends committee and staff meetings, as required
Performs related duties as required

Required Qualifications:


Current license to practice as a Registered Professional Nurse in New York State
3+ years clinical experience
Keep abreast of all changes in policies and procedures relating to Utilization Management and Case Management
Bachelor's degree
Preferred Qualifications:
 

1+ years Case Management Experience
Hospital-based experience writing appeals to refute clinical denials
1+ years of clinical experience including, utilization management, discharge planning; third party payment systems; and appeals and denial processes
Medical Coding or CDI experience
Health care isn't just changing. It's growing more complex every day. ICD10 replaces ICD9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and health care organizations continue to adapt, and we are a vital part of their evolution. And that's what fueled these exciting new opportunities.Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide.If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
  
Job Keywords: New York, NY, New Hyde Park, utilization management, case management, ICD 10, appeals, Quality