Case Manager-Denials/Appeals RN Per Diem CA TX

This is a Per Diem position. This position supports denials, appeals and compliance activities within the Care Management Department, including patient chart review, writing appeal letters and various audits supporting the Department and hospital in meeting regulatory requirements associated with Care Management. SPECIFIC SKILLS NEEDED – Excellent verbal, written, and organizational skills required – Ability to follow chain of command – Knowledge of medical terminology and current third party payor reimbursement methodologies – Self-motivated and results oriented. – Must be able to demonstrate sound decision making and prioritization skills, utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant others when administering or explaining care. EDUCATION/EXPERIENCE/TRAINING Required: Maintain active LVN CA and TX licenses Minimum of 2 years acute hospital experience Proficiency with main-frame and personal computers Preferred: Maintain active RN CA and TX licenses. Will accept RN CA temporary license. Managed care and case management experience