Clinical Finance Case Manager - RN

Job Summary

To support the Revenue Cycle Clinical Support team, the full-time Clinical Finance Case Manager - RN will manage complex pre-authorizations and clinical denials while working remotely, utilizing clinical knowledge to interpret medical necessity guidelines and collaborating with multidisciplinary teams.

Key responsibilities

• Implement and support clinical pre-certification, case reviews, and denial management processes
• Determine appropriate levels of care by interpreting clinical information and payer guidelines
• Act as a Subject Matter Expert for assigned payers and maintain awareness of healthcare trends and compliance requirements

Required qualifications

• Bachelor's degree in nursing with a current license
• Minimum of 2 years of clinical care experience
• Experience collaborating with physicians and understanding care plans
• Strong analytical skills and ability to synthesize large volumes of information
• Proficiency in Microsoft Office and various technology applications