Employer Industry: Healthcare Services

Why consider this job opportunity:
- Salary range up to $114,999.25 per year, depending on experience
- Opportunity for career advancement and growth within the organization
- Work in a supportive and collaborative environment with a focus on compassionate patient care
- Join a nationally recognized healthcare system, named one of Fortune’s 100 Best Companies to Work For
- Engage in meaningful work that directly impacts patient outcomes and experiences

What to Expect (Job Responsibilities):
- Act as a senior expert consultant for Case Management to ensure high-quality patient care and efficient resource utilization
- Evaluate denials and non-certified days from third-party payors and consult with physicians to formulate appeals
- Serve as the liaison between the hospital and external organizations regarding regulatory and billing requirements
- Review surgery cases to ensure appropriate documentation and billing accuracy in the electronic medical record
- Make billing recommendations for medical and surgical accounts based on payor requirements

What is Required (Qualifications):
- Bachelor’s degree
- Active Registered Nurse license and one of the listed certifications (e.g., ACMA ACM Certification, CCMC Case Manager)
- Minimum of 2 years of hospital or payor Utilization Management review experience required
- Strong written and interpersonal communication skills
- Ability to work independently and exercise sound judgment in interactions with healthcare teams and patients

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 preferred
- Experience in case management and utilization review/surgery pre-anesthesia preferred
- MCG Certification or eligibility to pursue within 90 days of hire

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