Clinical Finance Case Manager - RN

Job Summary

Working remotely in a full-time capacity, the Clinical Finance Case Manager - RN will implement clinical pre-certifications, manage complex billing scenarios, and secure pre-authorizations while collaborating with multidisciplinary teams to prevent and appeal clinical denials.

Key responsibilities

• Manage complex pre-authorizations and clinical denials through analysis of medical necessity guidelines
• Collaborate with physicians and departments to ensure compliance with payer requirements and audits
• Utilize clinical knowledge to interpret documentation and determine appropriate levels of care

Required qualifications

• Bachelor's degree or equivalent experience; must be a Registered Nurse
• Minimum of 2 years of clinical care experience with a strong understanding of patient needs and physician plans
• Proven analytical skills with the ability to synthesize large volumes of information
• Extensive knowledge of clinical operations, patient flow, and utilization management guidelines
• Proficiency in Microsoft Office products and ability to navigate multiple applications quickly