Centura Health connects individuals, families and neighborhoods across Colorado and western Kansas with more than 21,000 of the most talented hearts and minds in medicine.
Through Centura Health’s 17 hospitals, two senior living communities, health neighborhoods, physician clinics, Flight for Life® Colorado, home care and hospice services, we offer a diverse range of work settings in a Colorado or Kansas community you will love to call home.
Enjoy amazing people, competitive pay, some of the best benefits in the industry and plenty of opportunity for professional growth and development.
If you’re ready to discover the difference of working for a fully-integrated health system with a non-profit, faith-based mission to care, we look forward to receiving your application.
The RN Case Manager within Revenue Management is a part of the Denials Management Team and may be responsible for reviewing either inpatient or outpatient denials. Using a collaborative, interdisciplinary approach with Revenue Management, Hospital Case Management Directors and the Hospital Revenue Management Team, the RN Case Manager researches available information with the objective of providing clinical expertise and guidance in order to facilitate claim payment and reimbursement at the highest level.
RN licensed in state of CO
Working knowledge of Milliman Care Guidelines or InterQual
WORK EXPERIENCE REQUIREMENTS
4 years clinical experience as a Registered Nurse
2 years with experience in Case Management to include discharge planning and utilization review.
Coding or Clinical Documentation Improvement helpful
High level critical thinking skills and problem solving
Strong Organization skills
Ability to multitask
RN licensed in state of Colorado
Reviews denials forwarded by Appeals Specialists either formally or informally
Researches Medical Records and Payor denial reasons
Creates appeal letter specific to denial reasons and clinical scenario
Remains up to date on medical necessity guidelines, Standard of Practice and criteria used to determine levels of care
Keeps up to date with State and Federal Regulations
Maintains timely filing deadlines as established by Payor contract
Enters proper documentation in EPIC, Allscripts, Meditech or other documentation systems being used
Maintains collaborative relationship with hospital stakeholders in an effort to get claims resolved
Attends Case Management, Utilization Management or other meeting to educate, inform and provide consulting services to hospital facilities and stakeholders with the objective of identifying barriers effecting payment
Keeps up to date with trends in denials and appeals outcomes
Maintains collaborative relationships and provides feedback regarding day to day processes with the Denials and Appeals Team. This may include changing trends we have identified
Provides clinical education to Denials and Appeals Team when requested
X Sedentary Work - prolonged periods of sitting and exert/lift up to 10 lbs force occasionally
Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V.
Find your ideal career at Centura Health! With 16 hospitals, physician clinics, hospice services, home care and senior living communities, Centura Health's vast network of care spans Colorado and Western Kansas so you can experience a balanced lifestyle and enjoy a fulfilling career anywhere you want to work, live and play in Colorado. From the fast pace of a Denver-area Level 1 Trauma Center to a... smaller rural or mountain hospital – we proudly offer a more diverse range of work settings and locations than any other health care employer in the state. Centura is an equal opportunity employer.