2 Appeal Nurse Specialist Jobs in Hackensack, NJ
HMH HOSPITALS CORPORATION is Hiring an Appeal Nurse Specialist Near Hackensack, NJ
Our team members are the heart of what makes us better.
At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The Appeal Nurse Specialist will be responsible for the timely review and submission of appeals for denied managed care inpatient and/or outpatient claims to insurance companies for reconsideration of denials and/or level of care change determinations. Gathers and evaluates the information for appeals of Managed Care audits, clinical and technical denials by utilizing various Epic and legacy systems for Hackensack Meridian Health (HMH) hospitals. Responsible for following all regulatory compliance requirements. Serves as a functional expert and liaison to other departments within the hospital system (i.e.: patient access, patient accounting, and Care Management).
Qualifications:
Education, Knowledge, Skills and Abilities Required:
- Associate degree in nursing from an accredited School of Nursing.
- Minimum of three years of acute care nursing experience with knowledge of standard Utilization Management criteria, broad-based clinical knowledge, familiarity with critical pathways, current regulatory requirements, and legislation for third-party payers and payer practice patterns.
- Demonstrate qualities including time management, verbal and written communication skills and work organization.
- Demonstrates customer-focused and interpersonal skills to interact effectively with physicians, health team members, community agencies, insurers, and clients with diverse opinions, values, and religious and cultural needs.
- Excellent written and verbal communication skills.
- Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.
Education, Knowledge, Skills and Abilities Preferred:
- Bachelor's degree in nursing (BSN).
- Experience working in an acute health setting.
- Minimum of 1 year of case management or equivalent experience.
- Knowledge of Milliman Care Guidelines or Interqual.
Licenses and Certifications Required:
- NJ State Professional Registered Nurse License.
Licenses and Certifications Preferred:
- Certification in Case Management.
Job Summary
Full Time
Hospital
$91k-111k (estimate)
05/09/2024
07/07/2024
hackensackumc.org
EDISON, NJ
7,500 - 15,000
1888
NGO/NPO/NFP/Organization/Association
ROBERT CHARLES GARRETT
$1B - $3B
Hospital
Related Companies
About HMH HOSPITALS CORPORATION
HackensackUMC is a research and teaching hospital that provides inpatient and outpatient services.
