Integrated Care Manager, Registered Nurse (RN) – Inpatient and Outpatient Clinical Appeals

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🔥 4 hours ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $89.5k - $136.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Sentara Health is a leading healthcare system that operates over 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. The company is dedicated to providing exceptional patient care, fostering professional development, and maintaining a diverse workforce. Sentara Health aims to improve health every day and has been recognized for its clinical and operational performance, being named one of the top 15 health systems by IBM Watson Health. The organization supports its employees in achieving their full potential and encourages growth and innovation in the healthcare sector.

📋 Description

• Manage inpatient and outpatient provider appeals across all payer types, including government and commercial insurance • Review clinical denials that are non-billing related • Identify root causes of clinical denials • Perform post-claim analysis to support appeal submissions • Work as part of Sentara Health Plans, an integrated, not-for-profit healthcare delivery system • Support the organization's mission to improve health every day

🎯 Requirements

• N-3YR - RN-Diploma (Non-degree) REQUIRED • Registered Nurse (RN) License (Compact or Virginia) preferred • 3 years experience in Nursing REQUIRED • Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management preferred • Provider appeals experience is a plus • Strong proficiency in Excel • Standard working hours: 8am to 5pm EST, Monday through Friday • Must be able to work remotely from Virginia • Full-time availability, 40 hours per week

🏖️ Benefits

• Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Pet Insurance • Legal Resources Plan • Annual discretionary bonus opportunity, subject to established system and employee eligibility criteria • Educational assistance or student loan repayment • Voluntary benefits • Remote work arrangement • Family-friendly culture • Opportunities for development and growth

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