Ohio Licensed Clinical Financial Case Manager

Job Summary

To support the Revenue Cycle Clinical Support Office, the full-time Ohio Licensed Clinical Financial Case Manager will manage complex pre-authorizations, prevent and appeal clinical denials, and utilize clinical knowledge to interpret medical necessity guidelines while working remotely.

Key responsibilities

• Implement and uphold the standards, policies, and procedures of the organization while collaborating with a multidisciplinary team
• Determine appropriate levels of care and secure pre-authorizations by interpreting clinical documentation and payer guidelines
• Maintain expertise in payer requirements and conduct audits related to clinical appeals and denial management

Required qualifications

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