Clinical Denials, Nurse Specialist

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $80k - $105k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Huron

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2002

🤝 B2B

🏢 Enterprise

💸 Finance

B2B • Enterprise • Finance

Huron Consulting Group is a global consultancy that provides a wide range of services including strategy, operations, advisory, digital, technology, and analytics solutions to various sectors such as healthcare, education, energy, and financial services. Huron helps organizations navigate complex challenges and drive growth through tailored solutions and innovative strategies. The company employs a team of experts dedicated to delivering high-impact solutions that address the unique needs of each client, focusing on areas such as managed services, outsourcing, and leadership development.

📋 Description

• Assists in QA program build, including advising on the most critical aspects of the workflow/accounts to audit. • Monitors performance of all Utilization and Denials Management staff. • Escalate Production and QA concerns or roadblocks to the Manager. • Work closely with the Training teams members to communicate progress across the Team to the Manager. • Demonstrates domain expertise in quality process related to meeting production schedules. • Completes any special projects, such as full Utilization and Denials Management audit. • Conducts monthly team meetings and annual performance evaluations with team members. • Partner with global Operations, Training, and HR to streamline onboarding.

🎯 Requirements

• Atleast 1 year of Utilization management and/or Clinical appeals writing QA or auditing experience in healthcare setting. • Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years if ICU experience. • Bachelor of Science in Nursing. • Must be Registered Nurse and with active USRN license. • Proficiency in using InterQual or MCG clinical guidelines. • Broad Knowledge of U.S. Government Programs and Insurance Regulations. • Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech.

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Remote work options • Wellness programs