Denial Specialist/Lead UM Case Manager
2776 Cleveland Ave, Fort Myers, FL
Department: Rehab - Performance Mgmt
Shift: 8:00 AM-4:30 AM
|Ensures that reimbursement issues related to medical necessity are resolved to the best of his/her ability. Coordinates the Rehabilitation Hospital’s proactive and retrospective denial management processes including but not limited to staff education, collaboration with payers, audits, data analysis, trend identification, performance improvement initiatives and CARF accreditation preparedness. Serves as the hospital clinical liaison which conducts within stay utilization review and has responsibility for obtaining within stay insurance authorizations, monitoring, tracking and reporting changes, regulatory or otherwise, that impact reimbursement. |
|Degree/Diploma Obtained||Program of Study||Required/|
|Minimum Years Required||Area of Experience||Required/|
|3 Years||Utilization Review/Management||Required|
Denials and appeal experience preferred.
State of Florida Licensure Requirements
|Registered Nurse License||Required|
|ACM (Accredited Case Manager)||Required||or|
|NACCM (National Academy of Certified Care Managers)||Required||or|
|CPUR (Certified Professional Utilization Review)||Required|
Require Case Management Certification, ACM, CCM, CMCN or CPHM after 2 yrs. employment (time exception given for unsuccessful attempts).