Case Manager, Denials and Appeals, 40 Hours (Days)
BMC Company LLC(1 month ago)
About this role
A Utilization Management Registered Nurse (Case Manager) supporting utilization review and care management within the Denials and Appeals department of a healthcare system. The role is clinical and collaborative, working with multidisciplinary teams and payers to align patient care with appropriate resources and reimbursement. The position requires nursing licensure and clinical experience.
Required Skills
- Utilization Management
- Case Management
- Medical Terminology
- Care Coordination
- Authorization
- Interpersonal Communication
- Data Analysis
- Negotiation
- ICD-9
- CPT
+1 more
Qualifications
- BS in Nursing
- Registered Nurse License (MA)
- CCM Certification (Preferred)
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