Clinical Finance Case Management - RN

Scope of Position:

• Revenue Cycle Clinical Support Office (RCCS) is responsible for Clinical Pre-Certification, Case Reviews, Pre-billing edits, in-patient account validations, supporting Utilization Management, Peer to Peer processes, complex billing scenarios, audits, clinical appeals and denial management.
• RCCS is integral to the Revenue Cycle and supports cash collection through preventing and appealing denials.

Position Summary:

• The Clinical Financial Case Manager - RN implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center.
• The CFCM-RN functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials.
• The CFCM-RN utilizes clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided.

Minimum Qualifications For Hire:

• Bachelor’s degree in nursing with current license required.
• Minimum of 2 years clinical care experience.
• Strong analytical skills and ability to make educated decisions.

Additional Information:

• Location: Remote Location.
• Scheduled Hours: 40 per week, First Shift.
• Final candidates subject to background check.