Massachusetts Licensed RN Administrator

Job Summary

A company is looking for a Denials and Appeals RN Administrator.

Key Responsibilities

• Manage the psychiatric pre-denial/denial and appeal process, ensuring appropriate patient placement based on admission criteria
• Utilize medical necessity screening tools to conduct initial and continued stay reviews for patient care determination
• Collaborate with payers to secure authorization for clinical services and follow the UR process as per established guidelines

Required Qualifications

• Nursing degree: Diploma, ASN or BSN (preferred), with the ability to obtain a BSN within 4 years
• MA RN License required
• CCM or ACM certification preferred
• 3-5 years of related experience in healthcare case management and patient insurance/billing
• Preferred supervisory experience of 3-4 years