- Excellent interpersonal, verbal and written communication skills, particularly telephone.
- Strong analytical and organizational skills with the ability to multi-task.
- Must have the ability to work independently and meet deadlines with attention to detail.
- Excellent time management and organizational skills.
- Must have a good understanding of medical terminology with ability to read, discuss and understand patient medical information.
- Must have the ability to interact effectively with a variety of people and situations at all levels of the organization.
- Ability to stay current on changing governmental and payor regulations related to authorization/certification processes.
- Knowledge of and adherence to commercial, managed care, government and audit appeal processes and timelines and the financial implications to the Ministry.
- Ensures knowledge is kept relevant on all nationally recognized Payor Criteria guidelines.
- Maintains technical knowledge and skills of computer system including but not limited to Office 365, EPIC and Payor based websites.
- Ability to fully utilize automation to achieve departmental goals.
- Ability to demonstrate personal qualities such as kindness, compassion, understanding, creativeness, integrity, interest, influence and respect for others.
- Position requires the ability to push, pull, and/or lift 50 lbs on a regular basis.
- Position requires prolonged standing and walking during each shift.
- Position requires the ability to grip, reach, bend, kneel, twist, and squat to perform duties.
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How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we ser ...
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Immediate need for a talented Assistant Nurse Manager - Adult Emergency Department. This is a Fulltime, Evening shift opportunity with long-term potential and is located in Augusta, Georgia. (Onsite). Please review the job description below and contact me ASAP if you are interest ...
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Job Description: · This job description applies to Nurse Manager and Nurse Manager-Complex.The difference is the scope level below.This role involves managing and supervising nursing departments. Collaborating with nursing leaders and other facility managers and departments, the ...
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Immediate need for a talented Assistant Nurse Manager - Adult Emergency Department. This is a Full-Time opportunity with long-term potential and is located in Augusta, Georgia (Onsite). Please review the job description below and contact me ASAP if you are interested. · Job Diva ...
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Caduceus is seeking an experienced Registered Nurse (RN III) to serve as a Non-Clinical Medical Case Manager supporting the Maine Army National Guard's medical readiness mission. · Registered Nurse qualified to perform non-clinical medical case management with a Bachelor of Scien ...
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Immediate need for a talented Registered Nurse Manager – Radiology. This is a Fulltime opportunity with long-term potential and is located in Augusta, Georgia (Onsite). Please review the job description below and contact me ASAP if you are interested. · Job ID: · Pay Range: $33 ...
Augusta23 hours ago
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Find your calling at Mercy · This position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; collaborating to include coordination as evidenced by ...
Augusta17 hours ago
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Find your calling at Mercy · This position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; collaborating to include coordination as evidenced by ...
Augusta21 hours ago
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We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. · At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize sa ...
Augusta, ME3 weeks ago
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We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...
Augusta $54,095 - $116,760 (USD)3 days ago
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We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. · The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, · responsible for coordinating care for members who ...
Augusta $54,095 - $116,760 (USD)3 weeks ago
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We are seeking a Registered Nurse Case Manager to support the Maine Army National Guard (MEARNG) in Augusta, ME. In this role, you will support Soldier medical readiness by coordinating non-clinical case management activities, · Review privacy rights with Service Members and secu ...
Augusta, ME3 weeks ago
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We are seeking a Registered Nurse Case Manager to support the Maine Army National Guard in Augusta, ME. In this role, you will coordinate non-clinical case management activities and medical records tracking to help maintain Individual Medical Readiness. · This is a full-time oppo ...
Augusta Full time3 weeks ago
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· NEEDED: Registered Nurse III – Case Manager · LOCATION(S): · 194 Winthrop Street, Camp Keyes, Augusta, Maine 04333 · 11 Ordnance Rd., Brunswick, Maine 04011 · Regional Training Institute: 289 Hildreth St., Bangor, Maine 04401 · QUALIFICATIONS: · Must be a Registered Nurs ...
Augusta, ME1 week ago
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DT-Healthcare Staffing is seeking a local contract nurse RN Clinic Manager for a local contract nursing job in Augusta, Maine.This is a non clinical role. You will not provide bedside care. You will manage medical readiness cases and documentation. · ...
Augusta $47 - $51 (USD)2 weeks ago
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Make a difference every day as an Amedisys RN case manager. Join Amedisys-one of the largest and most trusted home health and hospice companies in the U.S.-where flexibility, purpose and growth come together to help patients heal where they feel most comfortable, at home. · ...
Augusta $85,000 - $90,000 (USD)2 weeks ago
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We are seeking a Non-Clinical Nurse Case Manager to support the Maine Army National Guard (MEARNG) in Augusta, ME. In this role, you will support Soldier medical readiness by coordinating non-clinical case management activities, · This is a full-time opportunity in which we'll pr ...
Augusta Full time3 weeks ago
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We are seeking a Non-Clinical Nurse Case Manager to support Soldier medical readiness by coordinating non-clinical case management activities, · readiness event follow-up,and medical records tracking. · ...
Augusta, ME3 weeks ago
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Amedisys invites you to join their team as a Hospice Registered Nurse Case Manager in coastal areas around Boothbay. · As part of the team, you will have attractive pay and benefits package including paid time off, · a full suite of insurance options, · and opportunities for prof ...
Augusta $85,000 - $90,000 (USD)1 month ago
Remote - Appeal Management Nurse - Augusta - Mercy
Description
Find your calling at MercyThis position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practices.
The Appeal Management Nurse will provide guidance, coaching, staff development and problem solving for Mercys clinical improvement and compliance initiatives.
Position Details:
Education:
Graduate of an accredited School of Nursing required
Experience:
2 years in acute care hospital setting required
Licensure:
Current license in the state of residence and/or employment required.
Preferred Qualifications:
Experience:
Care Management, Utilization Management, and/or Appeal Management experiences preferred
Other Skills, Knowledge, Abilities:
Preferred Education:
Bachelor of Science in Nursing.
Physical Requirements:
Why Mercy?From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters.At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion.
As we grow, you'll grow with us.
By applying, you consent to your information being transmitted to the Employer by SonicJobs.
See Mercy Terms & Conditions atand Privacy Policy atand SonicJobs Privacy Policy atand Terms of Use
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