Froedtert Health
The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
EXPERIENCE DESCRIPTION: A minimum of 5 years of acute care nursing experience is required. Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required. TRAINING DESCRIPTION: Previous experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 Coding Guidelines. SPECIAL SKILLS DESCRIPTION: Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel. Analytical skills necessary to prepare statistical reports and develop solutions to problems. Technical writing ability for appeal letters and reports. LICENSURE DESCRIPTION: Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).
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Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.
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Basic
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$34
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