Current Registered Nurse license in New York State required.
8-12 years of relevant experience in healthcare management.
7+ years of leadership experience in a clinical setting.
Specialized certifications as needed.
Responsibilities
Lead the Appeal Resolution group by developing staff and fostering consensus on goals.
Develop and communicate a strategic vision for the appeals process.
Direct and organize staff activities related to clinical reviews and denials.
Act as a liaison between commercial payers and managed care organizations.
Report operational performance and corrective actions to management.
Perform related duties as required.
Benefits
Paid Time Off (PTO).
Medical, Dental, and Vision Coverage.
Health and Dependent Care Flexible Spending Accounts.
Health Savings Account.
401(k) Retirement Plan.
Basic Life and AD&D insurance.
Wellness Programs.
Employee Assistance Program.
Team Member Discounts.
Full Job Description
Description
Summary:
Directs, plans, and organizes the staff and activities related to denials and appeals for the organization. Functions as the health system's resource and liaison between commercial payers, managed care and third-party review organizations in managing the appeals/denials process. Reports on operational performance, justification and/or corrective action to management.
Responsibilities:
Leads the Appeal Resolution group by communicating with and developing staff members, and building consensus for programs and goals that support a business, function or geographic area.
Develops and articulates a short-term strategic vision for areas of responsibility.
Directs, plans, and organizes the staff and activities related to clinical reviews, denials and appeals for the organization.
Functions as the health system's resource and liaison between commercial payers, managed care and third party review organizations in managing the clinical reviews, appeals and denials process.
Reports on operational performance, justification and/or corrective action to management.
Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act.
Duties not mentioned here, but considered related are not essential functions.
Education Skills Experience:
Bachelor of Science in Nursing required.
Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.
8-12 years of relevant experience and 7+ years of leadership / management experience, required.
Company: Nuvance Health
Org Unit: 2092
Department: Care Coordination
Exempt: Yes
Salary Range: $59.84 - $111.12 Hourly
"Available benefits include: Paid Time Off (PTO); Medical, Dental and Vision Coverage; Health and Dependent Care Flexible Spending Accounts; Health Savings Account; 401(k) Retirement Plan; Basic Life and AD&D insurance; Wellness Programs; Employee Assistance Program; and Team Member Discounts. Available benefits for union positions may vary in accordance with applicable Collective Bargaining Agreements."
