Denials and Appeals RN Lead

Baptist Health Arkansas • Little Rock, AR, United States • $200k - $250k / year • 4m ago

Shift: Day

Working Hours: Varies for a total of 40 hrs/week

Summary:
Under general direction of the System Director of Utilization Management, the Denial Lead will be responsible for managing inpatient lack of medical necessity related denials by reporting on and looking for opportunities to improve denials through UM reviews, physician documentation and workflow processes. Where warranted, the Denials Lead RN will collect, organize and present pertinent clinical information to third party payers. The Denial Lead will also process and track clinical denials for the healthcare system.

Minimum Requirements:
Bachelor's degree in Nursing or an equivalent degree in a related discipline required, as well as a current state issued RN license. Must be able to interpret and utilize MCG and/or other evidence-based criteria. Knowledge of third party payer regulations related to Utilization Review is preferred.

This job will be authorized 80.00 hours bi-weekly.

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