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Company: Southern Illinois Healthcare
Location: Carbondale
Posted on: November 26, 2022

Job Description:

Responsible for supporting case management and compliance functions and serves as an internal consultant. Responsibilities Safety - Manages processes effectively in regard to employee/patient safety. - Record Keeping - Maintains all required records, reports, statistics, logs, files and other documents as required. - Process Improvement - Promotes a culture of process improvement by participating in unit/department based programs that supports the system's process improvement goals. - Actively participates on system-wide or hospital-based teams as needed. - Role Specific Responsibilities - Compiles and analyzes medical necessity denial data from three facilities to determine level of appeal needed, implements appeals, and performs follow up processes. - Develops, coordinates and presents focused education sessions for SIH personnel and medical staff related to medical necessity denials and other process issues. - Researches and compiles regulatory information/data and provides written and oral reports to senior leadership and medical staff. - Adapts to regulatory changes and develops improvement opportunities. - Participates in the denial management process, including medical necessity review for Recovery Audit Contractor (RAC). - Acts as the case management liaison for participation on the RAC teams. - Prepares multi-level written appeals. - Provides second level review for non-billable admissions and coordinates notification of confirmed cases to business office. - Qualifications Education - Bachelor's degree in Nursing preferred Licenses and Certification - Current Illinois RN License Experience and Skills - Technical Experience: 3 years #PIQnursing - COVID vaccinationPandoLogic.Keywords:Registered Nurse (RN), Location:Carbondale,IL-62901, PL:545730223

Keywords: Southern Illinois Healthcare, Evansville , RN DENIAL/APPEAL COOR, Healthcare , Carbondale, Indiana

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