Award Winning Care
At OhioHealth, we achieve a rare balance between exceptional healthcare and integrity. As we push the limits of science, we never lose sight of our heartfelt mission and sense of community.
We’re a tight-knit group that discovers and succeeds together. As a part of our team, you’ll sharpen the skills and expand the knowledge you need to be at the top of your profession.
And because our achievements never outshine our values, we have been consistently ranked a top employer by Fortune Magazine.
Position Summary
This position assists in development, implementation, refinement and reporting of the RAC case management and appeals program. It is accountable for reviewing documentation of clinical care provided, financial outcomes of an assigned population, coordinating clinical documentation, drafting appeal letters and identified for RAC audits and appeals in response to a claims denial from the RAC. He/She works collaboratively with all interdisciplinary staff internal to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of the RAC case management appeals process.
Minimum Qualifications
MINIMUM QUALIFICATIONS
RN from an accredited school of Nursing and currently licensed in the State of Ohio. Bachelor's degree in nursing or health related field. Clinical expertise in a care setting with background in case management appeals and denials. Specialized knowledge in coding guidelines. Computer skills/data entry. Data entry analysis skills. Writing skills. Staff RN experience. 2-5 yrs nursing experience in specialized nursing area.
DESIRABLE QUALIFICATIONS
Advanced training in case management, or certification in case management or clinical specialty. Master's Degree in related field. Case management and/or performance improvement experience. Experience in financial analysis. Experience in group/collaborative teamwork process. Clinical experience in advanced practice role. Experience in teaching. Appeals experience at all levels of appeal, including at the Administrative Law Judge level and higher.
Additional Job Information
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Scheduled Hours Per Week
20
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains
compliance with all state, federal, and local regulations. OhioHealth does not discriminate
against associates or applicants because of race, color, religion, sex, sexual orientation, age,
ancestry, national origin, veteran status, pregnancy, disability, marital status, or other
characteristics protected by law. Equal employment opportunity is extended to all persons in all
aspects of the associate-employer relationship including recruitment, hiring, training, promotion,
transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any
other term or condition of employment.