Attention current TriHealth employees:
Please apply for this position by submitting an online internal application via SuccessFactors.Please be certain to update your SuccessFactors Employee Profile prior to applying to this position.
UTILIZATION AND APPEALS COORDINATOR: This position may perform utilization management functions on a prospective, concurrent or retrospective basis in order to maximize revenue for TriHealth. This includes analysis of clinical information presented with comparison to established national clinical criteria to determine appropriate place of service such as inpatient/outpatient/observation and medical necessity for ongoing inpatient care. In addition, understands all government and health plan requirements while negotiating with health plan to obtain authorization for services or payment on denied claims. This staff works independently with a high level of autonomy and decision making surrounding high dollar services and revenue.
EDUCATION: Associate's Degree or Diploma in Nursing New hires required to obtain BSN within 5 years of hire. Registered Nurse Current Ohio licensure
EXPERIENCE: 5-7 years Clinical in Nursing hospital based
SPECIALIZED KNOWLEDGE: .
Word, Excel, exceptional written and oral communication skills.
Job Title: UTILIZATION AND APPEALS COORDINATOR
Department Name: TRIS PATIENT ACCOUNTING
Employment Status: Full Time Position
Weekend Commitment: No
Holiday Commitment: No
On-Call Commitment: No
Nearest Major Market: Cincinnati
Job Segment: Medical, Nursing, Registered Nurse, Healthcare
Posting ID: 556638538Posted: 2020-05-21