Employer Industry: Healthcare

Why consider this job opportunity:
- Salary up to $114,999.25 per year, depending on experience
- Opportunity for career advancement and growth within the organization
- Collaborative and supportive work environment
- Chance to make a positive impact on patient care and outcomes
- Work with a highly recognized healthcare system, named one of Fortune’s 100 Best Companies to Work For

What to Expect (Job Responsibilities):
- Serve as a senior expert consultant for Case Management, ensuring high-quality patient care and efficient resource utilization
- Evaluate denials and non-certified days from third-party payors, and formulate appeals as necessary
- Consult with physicians and case managers to determine medical necessity and prepare formal appeals
- Liaise between the hospital and external organizations, including eQ health and CMS, for appeals and regulatory compliance
- Review surgical cases to ensure appropriate billing and documentation before submission

What is Required (Qualifications):
- Bachelor’s degree
- RN license and one of the listed certifications (e.g., AAMCN Utilization Review Professionals, CCMC Case Manager)
- Minimum of 2 years of hospital or payor Utilization Management review experience
- Excellent written and interpersonal communication skills
- Strong critical thinking, analytical, and time management skills

How to Stand Out (Preferred Qualifications):
- 3 years of hospital clinical experience preferred
- Current working knowledge of payor and managed care reimbursement
- Familiarity with CPT, ICD-9 & -10, and DRG coding
- MCG Certification or eligibility to pursue within 90 days of hire
- Case management and utilization review/surgery pre-anesthesia experience preferred

#Healthcare #CaseManagement #PatientCare #CareerOpportunity #HealthcareProfessionals

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