DENIAL MGMT CLINICAL ANALYST

Minimum Level of Education Required: Bachelor's degree

Additional requirements:

Type of degree: Nursing

Area of study or major: N/A

Licensure/Certification/Registration

§ Registered nurse with valid Ohio license. Certification in area of clinical specialty preferred

Experience

Minimum Level of Experience Required: 3 - 5 years of job related experience

Prior job title or occupational experience: Case management, Utilization review

Prior specific functional responsibilities: N/A

Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations

Other experience requirements: Knowledge of InterQual and MCG, performance improvement, Medicare rules and regulations

Knowledge/Skills

Personal computer skills required, including use of Microsoft Word, Microsoft Excel, EPIC

Experience in gathering information, monitoring indicators, and feedback mechanisms is required.

Strong interpersonal skills required

Ability to research, evaluate information, analyze problems and make appropriate recommendations required

Demonstrated conflict resolution skills required

Assertive communication skills required