Clinical Financial Case Manager – RN

Job not on LinkedIn

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

The Ohio State University, Main Campus

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 1870

📚 Education

Education

The Ohio State University, Main Campus is a public research university located in Columbus, Ohio. It offers a comprehensive education with a wide array of undergraduate, graduate, and professional programs. The university is engaged in numerous research initiatives and partnerships, providing opportunities for students, faculty, and industry partners to collaborate. Ohio State promotes a vibrant student life with various academic, recreational, and wellness services to support student needs. It also emphasizes community involvement and leadership development, fostering an inclusive environment on its multiple campuses across Ohio.

📋 Description

• Implement and support the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center • Function within a multidisciplinary team to secure complex pre-authorizations and prevent or appeal clinical denials • Apply clinical knowledge and medical necessity guidelines to determine appropriateness of services • Determine the appropriate level of care, including Inpatient or Observation, by interpreting documented clinical information • Become a Subject Matter Expert for assigned payers and governmental payer requirements and audits, including RAC, MAC, and QIO • Maintain awareness of healthcare trends, JCAHO, CMS, and third-party payer Utilization Management guidelines • Interpret payer remits, denial and remark codes, and expected reimbursement to assess appeal cost effectiveness • Troubleshoot, problem solve, continuously learn, and adapt to changing payer rules • Work independently and collaborate closely with Legal, Medical Information Management, physician groups, and the Business Office • Support clinical pre-certification, case reviews, pre-billing edits, inpatient account validations, Utilization Management, peer-to-peer processes, billing scenarios, audits, clinical appeals, and denial management

🎯 Requirements

• Bachelor’s degree in nursing with current license required • Minimum of 3 years clinical care experience caring for patients, anticipating their needs, and understanding the physician’s plan of care • Experience collaborating with physicians and their designees • Strong, proven analytical skills • Ability to make educated decisions • Extensive knowledge of clinical operations and patient flow • Skilled at synthesizing large volumes of information and communicating concisely verbally or in writing • Proficient in Microsoft Office products including Word, PowerPoint, Excel, SharePoint, Teams, and OneNote • Proficient in Adobe Professional • Proficient in email, fax machines, copy machines, and internet browsers • Proficient typing skills • Proficient in technology, computer, and web applications • Ability to multitask and move between applications quickly and frequently • Ability to orient oneself to new applications quickly • Ability to manage multiple applications including IHIS, Microsoft Office products, 3M, and payer websites/applications • Successful completion of a background check; drug screen or physical may be required during the post-offer process

🏖️ Benefits

• Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost • Paid time off, including sick and vacation time and 11 holidays • State retirement plan or an alternative retirement plan, both with generous employer contributions • Comprehensive benefits • Equal opportunity employment, including veterans and disability