RN - NURSE COORDINATOR, UTILIZATION REVIEW DENIALS & APPEALS

Shift:Monday - Friday, 8am - 5pm
Department: Utilization Management - Remote
Compensation:

* Base Pay Range: $71,676 - $106,121 per year, based on experience

ABOUT THE JOB

MU Health Care is seeking a dynamic Nurse Coordinator for Utilization Review Denials & Appeals. We need an assertive and detail-oriented professional to champion the appeals process, ensuring optimal reimbursement by crafting compelling appeals and collaborating with key stakeholders. The ideal candidate will thrive in a fast-paced environment, adept at identifying and addressing denial trends while maintaining compliance with regulatory standards. We're looking for someone with resilience, innovation, and a commitment to excellence in coordinating appeals and managing external audits. If you're ready to make a significant impact and drive positive change in healthcare, join MU Health Care in delivering exceptional patient care through your expertise in appeals coordination.

ABOUT MU HEALTH CARE

At MU Health Care, we have an inspired, hard-working and collaborative environment driven by our mission to save and improve lives. We believe anything is possible and rally around solutions. We celebrate innovation and offer opportunities to be a part of something bigger - to have a voice and role in the work that is serving our community and changing the field of medicine.

Our academic health system - the only in mid-Missouri - is home to multiple hospitals, including the region's only Level 1 Trauma Center and region's only Children's Hospital as well as over 90 specialty clinics. Here, you can define your career among our many clinical and nonclinical positions - with growth, opportunity and support every step of the way.

Learn more about MU Health Care.

Learn more about living in mid-Missouri.

EMPLOYEE BENEFITS

* Health, vision and dental insurance coverage starting day one

* Generous paid leave and paid time off, including nine holidays

* Multiple retirement options, including 100% matching up to 8%and full vesting in three years

* Tuition assistance for employees (75%) and immediate family members (50%)

* Discounts on cell phone plans, rental cars, gyms, hotels and more

* See a comprehensive list of benefitshere.

DETAILED JOB DESCRIPTION

Review/direct the review of clinical denials and determine the appropriateness of appeal.

Collaborate with Medical Advisor for Utilization Management, revenue cycle, and clinical department managers to achieve maximum appropriate reimbursement. Collaborate with payer representatives to address payer denial trends/issues.

Coordinate appeals through research and collection of pertinent clinical documentation for appeal, communicating with the physician of record and other care providers as necessary; Direct/develop letters of appeal to various payers.

Develop reports and address trends by payer or federal audit initiative with corrective action plans engaging other departments as appropriate. Provide reports to clinical departments and direct corrective actions such as improved documentation, improved discharge planning, etc.

Direct all appeal documentation for external government audit processes such as Missouri Department of Insurance and federal Administrative Law Judge RAC, MIC, etc.

Identify and recommend to the Manager and Medical Advisor, cases requiring notification to state and/or federal agencies such as the Missouri Department of Insurance and federal Administrative Law Judge using statutorily defined processes.

Maintain knowledge of contracts and regulations related to clinical denials and appeals processes.

May complete unit/department specific duties and expectations as outlined in department documents.

KNOWLEDGE, SKILLS, AND ABILITIES

Skills in data management and reporting required including ability to write reports.

Knowledge of InterQual and Millman.

Excellent written and verbal skills.

Leadership skills.

REQUIRED QUALIFICATIONS

Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days.

Two (2) years of nursing experience.

PREFERRED QUALIFICATIONS

Bachelor of Science in Nursing degree.

Five (5) years of nursing experience, including discharge planning, utilization review, case management, or medical auditing.

Additional license/certification requirements as determined by the hiring department.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

The University of Missouri is an Equal Opportunity Employer.