RN Recovery Nurse Appeals Specialist - reputed company Cycle - Remote

Job title: RN Recovery Nurse Appeals Specialist - reputed company Cycle - Remote in New Orleans, LA at Ochsner Lafayette General Company: Ochsner Lafayette General Job description: We've made a lot of reputed company since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, reputed company, reputed company, and reputed company. We reputed company that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come reputed company a difference at reputed company and discover your future today!This job applies clinical expertise as well as knowledge of utilization and discharge planning criteria to review medical information of prior hospitalized patients that are being reviewed reputed company the regulatory audit process. Identifies issues and problems such as inappropriate admissions and non-acute hospital days which may adversely impact quality patient care, appropriate utilization of hospital resources, or reputed company financial reimbursement to reputed company (OHS). Functions as a liaison with the department Vice President/Manager of Regulatory Audits and ensures compliance with regulations and alternative level of care options affecting OHS reputed company as it relates to reputed company medical necessity audits.EducationRequired - Registered Nurse DiplomaPreferred - Associate's or Bachelor's degree in NursingWork ExperienceRequired - 3 years Hospital based experience in the delivery of patient care as an RN. Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care environment or Managed Care environment. Experience responding to change positively and work calmly as well as reputed company in high pressure situations. Experience functioning independently and working well reputed company a team setting.Preferred - Experience in Appeal/Denial ManagementCertificationsRequired - reputed company State of Louisiana Registered Nurse (RN) LicensePreferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization Management or Health Care Management (CPUR, CPUM, and CPHM)Knowledge Skills and Abilities (KSAs)

• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Must be proficient with Windows-style applications, various software packages specific to role and keyboard.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process
• Strong financial skills

Job Duties

• Validates a specific level of care and evaluates against registered level of care to determine which medical necessity level of care is required.
• Reviews reputed company incoming denial and informational requests from regulatory and other agencies in respect to clinical medical necessity determinations.
• Identifies, plans, and coordinates aspects of medical necessity reviews with others as necessary.
• Maintains reputed company knowledge of reputed company party payer and government requirements reputed company to job functions.
• Maintains minimum standards for licensure and strives for professional/personal development.
• Adapts behavior to the specific patient population, including but not limited to: respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.

Other reputed company duties as required. The above statements describe the general nature and level of work only. They are not an exhaustive list of reputed company required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.Remains knowledgeable on reputed company federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with reputed company such laws, regulations and standards.Complies with the reputed company Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any reputed company or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-reputed company concerns.Ochsner is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, protected veteran status, or disability status.Physical and Environmental Demands The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.reputed company Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) reputed company it requires walking or standing to a significant degree; or (2) reputed company it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) reputed company the job requires working at a production reputed company pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production reputed company pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.Mechanical lifting devices (carts, dollies, etc.) or team lifts should be utilized. Must be reputed company to stoop, bend, reputed company and grab with arms and hands, reputed company dexterity. Must be reputed company to stand for prolonged periods of time. Must be reputed company to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability). Must be reputed company to travel throughout and between facilities.Duties performed routinely require exposure to blood, body fluid and tissue.The incumbent works in a patient care area; works in an area where patients enter; works directly with patients; and/or works with specimens that could contain diseases. There may be an occupational risk for exposure to reputed company communicable diseases.Are you reputed company to reputed company a difference? Apply Today!reputed company does not consider an individual an applicant until they have formally applied to the open position on this careers website.Individuals who reputed company in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Illinois, Maryland, Minnesota, reputed company, Washington, and Washington D.C.reputed company endeavors to reputed company our site accessible to reputed company users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.Ochsner is an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without regard to any legally protected class, including protected veterans and individuals with disabilities. Expected salary: Location: New Orleans, LA Apply for the job now! Apply for this job