Ohio RN Clinical Financial Manager

Job Summary

To support the Revenue Cycle Clinical Support Office, the full-time remote Ohio RN Clinical Financial Manager will implement clinical pre-certifications, manage complex billing scenarios, and secure pre-authorizations while collaborating with multidisciplinary teams.

Key responsibilities

• Manage clinical pre-certifications and case reviews to prevent and appeal clinical denials
• Interpret medical necessity guidelines to determine appropriateness for services and level of care
• Act as a Subject Matter Expert for assigned payers and maintain awareness of healthcare trends and regulations

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
• Strong analytical skills with the ability to synthesize large volumes of information
• Proficiency in Microsoft Office and ability to navigate multiple applications quickly