RN DENIAL/APPEAL COOR - Carbondale, IL

Company: Southern Illinois Healthcare
Location: Murphysboro
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: Murphysboro, IL - 62966

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