Clinical Financial Case Manager, RN

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💸 Financial Planning and Analysis (FP&A)

👻 Ghost score 14%

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The Ohio State University, Main Campus

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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

• 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 • Use clinical knowledge to interpret and apply medical necessity guidelines • Determine the appropriateness of services provided • 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 state and national healthcare trends, JCAHO, CMS, and third-party payer Utilization Management guidelines • Acquire and apply knowledge across managed care, scheduling, financial counseling, pre-certification, admissions/discharges/transfers, clinical workflows and documentation, revenue management, coding, medical information management, case management, utilization management, clinical documentation improvement, compliance, legal, finance, transplant workflows, billing, follow-up, and cash posting • Read and interpret payer remits, denial/remark codes, and expected reimbursement • Determine the cost-effectiveness of completing an appeal • Troubleshoot, problem-solve, continuously learn, and adapt to changing payer rules • Work independently and collaboratively with Legal, Medical Information Management, physician groups, and the Business Office

🎯 Requirements

• Bachelor’s degree in nursing with current license required • Minimum of 2 years clinical care experience • Experience collaborating with physicians and their designees • Strong, proven analytical skills and ability to make educated decisions • Extensive knowledge of clinical operations and patient flow • Ability to synthesize large volumes of information and communicate concisely verbally or in writing • Proficiency in Microsoft Office products, including Word, PowerPoint, Excel, SharePoint, Teams, and OneNote • Proficiency in Adobe Professional • Proficiency using email, fax machines, copy machines, and internet browsers • Proficient typing skills • Proficiency in technology, computer, and web applications • Ability to multitask and move quickly between multiple applications • Ability to orient oneself to new applications quickly • Ability to manage multiple applications, including IHIS, MS 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

• Regular position • 40 scheduled hours per week • First shift • Remote work arrangement

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