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Clinical and Case Management Appeals Nurse - (22436)

Universal Health Services


Location:
RICHMOND, VA
Date:
04/24/2018
2018-04-242018-05-23
Job Code:
22436
Universal Health Services
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Job Details

Deltek Talent Management - Clinical and Case Management Appeals Nurse - (22436)

Job Details


Clinical and Case Management Appeals Nurse - (22436)

Facility Name
Atlantic Region CBO
Location
RICHMOND, VA 23227 US (Primary)
Career Area
Professional
Category
Other
Job Description

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One of the nation’s largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World’s Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.

Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.

Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.

The Atlantic Region CBO is seeking a dynamic and talented team member with clinical case management experience to support appeals of denial admissions and outpatient service.

Key Responsibilities include:

1. Analyze trends in insurance denials and work with insurance companies to implement ways to resolve underlying reasons for denials.

2. Manage recurring coding or clinical documentation issues and correct the underlying causes for error.

3. Use discretion, knowledge and independent judgment to resolve escalated Clinical Appeals issues.

4. Work as a liaison between Clinical Appeals and other departments to conduct billing and charging compliance in accordance with applicable Federal and State laws.

5. Perform QA for Clinical Appeals function.

6. Perform insurance defense audits as requested.

7. Consistently demonstrates HIPAA compliance with regard to patients’ protected health information.

 8. Provides clinical knowledge for CBO staff and consultation to management as needed.

 9. Manage daily activities related to the CBO’s Clinical Appeals function; ensuring processes are performed efficiently and effectively.

10. Other duties as assigned.

Job Requirements

Position Requirements:

  • RN or LPN licensure in good standing is required

  • Three to five years of experience is preferred

  • Strong Microsoft Office skills (Excel, Word, Outlook); customer focused both internally and externally, strong attention to detail, the ability to multi-task, strong 10 key data entry, and excellent written and oral communication skills are required.

     

    This opportunity provides the following:

  • Challenging and rewarding work environment
  • Growth and development opportunities within UHS and its subsidiaries
  • Competitive Compensation
  • Excellent Medical, Dental, Vision and Prescription Drug Plan
  • 401k plan with company match
  • Generous Paid Time Off

If you meet the above requirements and are looking for a rewarding career, please take a moment to share your background with us by applying online. UHS offers competitive compensation commensurate with experience and benefits programs including medical, dental, life insurance and 401k.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.

UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to "UHS or UHS facilities" on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms "we," "us," "our" or "the company" in such context similarly refer to the operations of Universal Health Services' subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including but not limited to UHS of Delaware, Inc.

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