Ohio RN Clinical Finance Specialist

Job Summary

A company is looking for a Clinical Finance Case Management - RN Specialist 2.

Key Responsibilities

• Implement and support clinical pre-certification and case reviews to secure complex pre-authorizations and prevent/appeal clinical denials
• Interpret medical necessity guidelines and determine appropriate levels of care based on clinical information
• Maintain expertise in payer requirements and audits, while staying updated on healthcare trends and utilization management guidelines

Required Qualifications

• Bachelor's degree in nursing with a current license
• Minimum of 3 years of clinical care experience
• Experience collaborating with physicians and understanding their plans of care
• Extensive knowledge of clinical operations and patient flow
• Proficient in Microsoft Office products and technology applications