Lead Nurse Consultant

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🏈 Alabama, Connecticut, +26 more states – Remote

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⏰ Full Time

🟠 Senior

💼 Consultant

👻 Ghost score 10%

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Revecore

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

Revecore is a healthcare revenue recovery company that combines proprietary AI, claims intelligence, workflow automation, and clinical, legal, and reimbursement expertise to identify and recover missed revenue for hospitals and health systems. Their ReClaim™ platform and network intelligence use machine-learning models and payor rule engines trained on hundreds of millions of claims to automate decisioning, prioritize recoveries, manage complex claims (VA, auto accidents, workers' compensation, Medicaid), denials management, underpayment recovery, and accounts receivable acceleration. Revecore operates HIPAA-compliant, SOC 2-certified infrastructure and serves over 1,300 hospitals, emphasizing outcomes like increased reimbursement, faster reimbursement, and high denial overturn rates.

📋 Description

• Oversee department operations related to clinical denials, focusing on team quality and efficiency. • Coordinate Clinical Case Study presentations for Revecore clients, including invitations, communications, and Nurse Consultant-level preparation. • Onboard, train, and mentor new nurses. • Participate in departmental quality assurance and ensure applicable guidelines and deadlines are met. • Assist Nurse Supervisors and the Manager with nurse workflow management. • Support nurses with account-related questions involving appeals and denial resolution. • Provide updates to Nurse Supervisors and the Manager on client communications, updates, issues, needs, staffing, and personnel matters. • Assist with client, payor, and company reports. • Support department work-plan management and updates. • Prepare and submit appeal letters, emails, online inquiries, and reports. • Build relationships with clients and Revecore personnel. • Attend client, department, and company meetings. • Comply with federal and state laws, company policies, and procedures. • Perform other duties as assigned.

🎯 Requirements

• College degree or diploma from school of nursing – must be a licensed RN. • Minimum 5 years of denials and appeals experience and/or hospital revenue cycle experience. • Experience with MCG, InterQual, NCD/LCDs, payor medical policies, and reimbursement policies. • Clinical nursing experience working in a hospital environment, preferably in ER, ICU, Med-Surg or Transplant unit. • Moderate computer proficiency, including working knowledge of Microsoft Word, PowerPoint, Excel, and PDF files. • Excellent interpersonal and communication skills. • Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division. • Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form. • Ability to write routine correspondence in English. • Strong customer service orientation. • Strong team player. • Commitment to company values. • Secure internet connection required. • Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. • Workspace must accommodate workstation equipment and related materials and provide adequate surface area. • Must reside in the United States within one of the listed eligible states. • Employment eligibility in the United States, employment-history verification, and successful completion of a background check.

🏖️ Benefits

• Remote work arrangement • Work-from-home setup with a quiet, distraction-free environment • Flexible work-from-home arrangement • Equal employment opportunity workplace