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Denial Specialist/Lead UM Case Manager

Location: 2776 Cleveland Ave, Fort Myers, FL
Department: Rehab - Performance Mgmt
Categories: Professional
Type: Full-Time
Shift: 8:00 AM-4:30 AM
Schedule: Days

Description:




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.

Requirements:

Educational Requirements

Degree/Diploma ObtainedProgram of StudyRequired/
Preferred
and/or
Bachelor'sNursingRequiredand

Experience Requirements

Minimum Years RequiredArea of ExperienceRequired/
Preferred
and/or
3 YearsUtilization Review/ManagementRequired

Additional Requirements

Denials and appeal experience preferred.

State of Florida Licensure Requirements

LicensesRequired/
Preferred
and/or
Registered Nurse LicenseRequired

Certifications/Registration Requirements

Certificates/RegistrationsRequired/
Preferred
and/or
ACM (Accredited Case Manager)Requiredor
NACCM (National Academy of Certified Care Managers)Requiredor
CPUR (Certified Professional Utilization Review)Required

Additional Requirements

Require Case Management Certification, ACM, CCM, CMCN or CPHM after 2 yrs. employment (time exception given for unsuccessful attempts).