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Nurse Manager - Denials Management
PH Denials Management
Full Time/ 8:00 a.m. -  5:00 p.m./80 Hours Per Payperiod

Position Summary
The Denials Management (DM) Nurse Manager (NM) is a masters' prepared registered professional nurse with advanced knowledge and expertise in process analysis, clinical outcome data analysis, denials management, utilization management, change management, outcomes management, utilization of information systems and regulatory requirements. The NM is knowledgeable regarding all components of the care delivery role provides direct supervision of Denials Management team members on day to day operations and provides guidance to physician offices, revenue cycle, and contracting.  The NM is experienced in clinical and financial integration across the continuum to ensure clinical and financial integrity for the organization. 
Masters Degree in Nursing, or Nursing Degree with MBA or Masters in Health Care related field. 

Registered Nurse with valid Ohio License

Certification: Certification in area of clinical specialty preferred. 

Minimum of 10 years of clinical experience preferred
Experience in a leadership role is required
Previous manager or experience required
Experience with utilization management, denials management and 3rd party Payors required
Demonstrated expertise in performance improvement process required
Demonstrated expertise in change management required
Knowledge of InterQual, Milliman, and 3rd party insurance requirements required
Knowledge of hospital reimbursement, third party billing, contracting and governmental rules and regulations regarding billing and reimbursement required

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