The Denial Nurse is responsible for being the “second line” resource for preparing and maintaining health plan criteria for the campus Medical Directors.
This includes collaborating with each Health Plan to obtain updated/adequate criteria for each specialty to ensure that appropriate criteria are referenced upon furnishing a denial. This includes questions regarding procedures, training, and processes to assure compliance with RMG/LMG policies and procedures.
The Denial Nurse assists the campus Regional Medical Directors and Inpatient Manager/Supervisor with daily operations and management of denials, training, auditing functions, and assuring that all staff provides a level of patient services that meets or exceeds the organization’s expectations.
The Denial Nurse will work collaboratively with Heritage and administration on the health plan template process.
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