Massachusetts Licensed RN Administrator
A company is looking for a Denials and Appeals RN Administrator. Key Responsibilities Manage the psychiatric pre-denial/denial and appeal process, ensuring appropriate patient placement based on admission criteria Utilize medical necessity screening tools to conduct initial and continued stay reviews for patient care determination Collaborate with payers to secure authorization for clinical services and follow the UR process as per established guidelines Required Qualifications Nursing degree: Diploma, ASN or BSN (preferred), with the ability to obtain a BSN within 4 years MA RN License required CCM or ACM certification preferred 3-5 years of related experience in healthcare case management and patient insurance/billing Preferred supervisory experience of 3-4 years
A company is looking for a Denials and Appeals RN Administrator.
Key Responsibilities
Manage the psychiatric pre-denial/denial and appeal process, ensuring appropriate patient placement based on admission criteria
Utilize medical necessity screening tools to conduct initial and continued stay reviews for patient care determination
Collaborate with payers to secure authorization for clinical services and follow the UR process as per established guidelines
Required Qualifications
Nursing degree: Diploma, ASN or BSN (preferred), with the ability to obtain a BSN within 4 years
MA RN License required
CCM or ACM certification preferred
3-5 years of related experience in healthcare case management and patient insurance/billing
Preferred supervisory experience of 3-4 years
