Ohio Licensed Clinical Financial Case Manager

Job Summary

A company is looking for a Clinical Financial Case Manager.

Key Responsibilities

• Implement and support clinical pre-certification and case reviews to secure complex pre-authorizations and prevent/appeal clinical denials
• Utilize clinical knowledge to interpret medical necessity guidelines and determine appropriateness for services provided
• Maintain awareness of healthcare trends and payer requirements while collaborating with multidisciplinary teams and departments

Required Qualifications

• Bachelor's degree in nursing with a current license
• Minimum of 3 years of clinical care experience
• Experience collaborating with physicians and their designees
• Proficient in Microsoft Office and technology applications
• Strong analytical skills and ability to make educated decisions