The Clinical Financial Case Manager RN provides advanced clinical appeal services with a focus on reviewing and escalating complex patient account denials
Job Summary
The Clinical Financial Case Manager RN provides advanced clinical appeal services with a focus on reviewing and escalating complex patient account denials.
This role independently evaluates payer contractual terms and policies to determine the need for escalation while monitoring denial trends to develop prevention strategies.
As an Escalation Lead, the position assists the manager in overseeing quality assurance, coaching staff, and aligning team operations with organizational goals.
Matching Summary
The Clinical Financial Case Manager RN provides advanced clinical appeal services with a focus on reviewing and escalating complex patient account denials.
Salary
Not specified; Not specified; Not specified
Skills & Requirements
Must-have
Current unrestricted RN license
5 years clinical appeals experience
2 years claim denial escalation
Medical necessity criteria knowledge
ICD-10 and CPT coding proficiency
Nice-to-have
Advanced nursing degree preferred
Leadership or mentorship experience
Process improvement initiative skills
Data analysis and trend identification
Professional certification in case management
Key Requirements
Bachelor's Degree in Nursing (BSN)
Minimum 5 years relevant professional nursing experience
Demonstrated working knowledge of MCG/InterQual criteria