Ohio RN Clinical Case Manager

Job Summary

Providing advanced clinical appeal services, the full-time Ohio RN Clinical Case Manager will manage complex patient account denials, perform clinical reviews, and assist in the development of denial prevention strategies while working remotely.

Key responsibilities

• Independently perform complex clinical reviews and evaluate payer contractual terms and policies for escalation needs
• Monitor and report on payer denial trends and assist in developing strategies to prevent denials
• Support the clinical appeals team by providing clinical and operational resources, coaching, and process improvements

Required qualifications

• Bachelor's degree or equivalent experience
• Registered Nurse (RN) license
• Minimum of 2 years of relevant experience required; 2-4 years preferred