Compliance Nurse Manager

Job summary
Compliance Nurse Manager positionResponsible for providing clinical input for denialsCritical in helping the dispute resolution strategy
Job seniority: mid-to-senior level
Responsibilities
• Provide information supporting legal efforts to pursue reimbursement for denied claims• Work with the Dispute Resolution Operations Team to ensure prompt completion of clinical reviews• Evaluate clinical review processes, productivity measurements, and department goals• Monitor clinical denial trends and provide reports and summaries• Provide feedback for improving clinical review and appeals processes• Train new team members and perform quality assurance• Build and maintain processes to maximize recoveries• Compose, edit, and review concise clinical evaluations for disputed claims• Utilize computer programs to track and monitor cases• Maintain understanding of rules, regulations, and policies impacting denials and appeals
Requirements
• Bachelor's Degree required• At least 3 years of case management or similar appeal experience required• At least 1 year of prior supervisory experience• State RN License required• Strong ability to research evidence-based practices
Key Skills Needed
• Strong research skills• Analytical thinking• Good communication• Attention to detail
Benefits
• Comprehensive medical coverage• Dental and vision benefits• 401(k) Plan with match• Employee Stock Purchase Plan• Family support benefits• Education assistance• Paid time off and disability coverage• Employee Health Assistance Fund