Employer Industry: Healthcare Services

Why consider this job opportunity:
- Competitive salary with opportunities for progression
- Comprehensive health plans available within 30 days of hire, including medical, dental, and vision
- Retirement package with up to 6% employer contribution
- Generous earned time off (ETO) for a healthy work-life balance
- Tuition reimbursement and repayment plans to support continued education
- Remote work flexibility with a focus on efficiency and quality

What to Expect (Job Responsibilities):
- Manage clinical denials through comprehensive reviews of clinical documentation
- Formulate timely and defensible written responses based on medical necessity criteria and documentation
- Communicate denial trends and patterns to patient accounting leadership
- Review and improve the enterprise clinical denial and appeal process
- Orchestrate education and performance improvement initiatives to enhance clinical quality

What is Required (Qualifications):
- Minimum of 3 years of Clinical RN experience, including 1 year in Denial Management or Case Management
- 1 year of current experience with reimbursement methodologies
- RN licensed by the Oregon State Board of Nursing or an active RN license in a state approved for remote work
- Bachelor's degree in Nursing or allied health field, preferred
- Experience in preparing appeals for clinical denials, preferred

How to Stand Out (Preferred Qualifications):
- Certified Clinical Documentation Integrity Specialist (CCDS) by ACDIS
- Certified Case Manager (CCM)
- Experience in denial management and case management processes
- Advanced knowledge of clinical documentation and medical policies

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