Similar Jobs
See allClinical Finance Case Management - RN
The Ohio State University
US
Clinical Nursing
Analytical Skills
Microsoft Office
Clinical Review Specialist
CorroHealth
US
RN License
Utilization Review
Clinical Documentation
Clinical Audit/Denials Specialist, RN
Northside Hospital
US
Case Management
Utilization Management
Coding
Medical Reviewer
Palmetto GBA
US
Clinical Review
Managed Care
Medical Terminology
Priority Claims Specialist
Jobgether
US
Medical Billing
Insurance Claims
Data Analysis
Responsibilities:
- Review patient medical records and utilize clinical knowledge to determine reasons for claim denials and complete appeals.
- Prepare convincing appeal arguments using pre-existing criteria sets and clinical evidence.
- Present data and analytics to leadership and provide feedback on trends to hospitals.
Qualifications:
- Five years’ experience as a clinical nurse in acute care; current RN license required.
- Significant healthcare experience with at least two to three years in case management, discharge planning, or utilization review preferred.
- Knowledge of regulatory payer requirements, InterQual, Milliman criteria, and MAC/RAC/ZPIC processes.
About PAM Health:
- PAM Health is based in Enola, Pennsylvania, and operates over 70 facilities in 17 states.
- The company offers competitive pay, generous paid benefit time, and excellent insurance options.
- Employees enjoy opportunities for professional growth through the Education Advancement Program.
PAM Health
PAM Health provides specialty healthcare services through over 70 long-term acute care hospitals, rehabilitation hospitals, wound clinics, and outpatient physical therapy locations in 17 states. With a collaborative culture and a focus on compassionate care, the company employs a dedicated team committed to high-quality patient outcomes and professional growth.