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Registered Nurse- UM Denials & Appeals

Company: WellStar Health System
Location: Marietta
Posted on: September 11, 2020

Job Description:

Overview

At WellStar, we all share common goals. That’s what makes us so successful – and such an integral part of our communities. We want the same things, for our organization, for our patients, and for our colleagues. As the most integrated healthcare provider in Georgia, this means we pride ourselves on investing in the communities that we serve. We continue to provide innovative care models, focused on improving quality and access to healthcare.

Responsibilities

The Registered Nurse (RN) - UM Denials & Appeals focuses on the review and analysis of medical necessity and authorization payer denials rationales and provides appropriate medical necessity appeal services. The Appeals Nurse will review all denial rationales and case-specific medical records for compliance, accuracy and completeness in accordance with departmental policies and regulations, medical necessity criteria set, payer regulations and other contractualrequirements. The appeal nurse will work in conjunction with the UM medical director in constructing appeal letters as appropriate.

Qualifications

Required Minimum Education

At least a 2-year degree in nursing required. Bachelor’s or above preferred

Required Minimum Certification

Must possess a current nursing license RN in state of GA

Required Minimum Experience

Minimum of 3 years of experience as a case manager, discharge planner, utilization review nurse required

Minimum of three years of experience as a staff nurse in an acute care setting

Required Minimum Skills

Proficient in typing

Experience with Microsoft Office suite

Ability to learn and understand various clinical software applications

Strong clinical judgment and multitasking ability

Excellent problem-solving skills

Self-motivation and ability of working independently with limited supervision and structure

Excellent interpersonal, verbal, and written communication skills

Join us for outstanding benefits and development opportunities. We also offer state-of-the-art technology, professional support and advancement, and colleagues that rank amongst the best in the country.

Step up to your potential. Find out more and apply today!

Keywords: WellStar Health System, Marietta , Registered Nurse- UM Denials & Appeals, Other , Marietta, Georgia

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