Nurse Consultant - Team LeadAs part of our team, you'll be rewarded with:
• Comprehensive medical, dental, vision, and life insurance benefits from the start of your employment
• 12 paid holidays and flexible paid time off
• 401(k) contributions
• Employee Resource Groups that build community
• Career growth opportunities
• An excellent work/life balance
Location: Remote - USA
Position Summary Primarily responsible for department operations related to clinical denials to optimize the function of the team with focus on quality and efficiency.
Key Responsibilities - Coordinate Clinical Case Study presentations for Revecore clients; manage invites and communications and oversee the preparation that occurs at the Nurse Consultant level
- Provide onboarding/training/mentoring of new nurse hires.
- Participate in the quality assurance process for the department, ensuring all applicable guidelines/deadlines are successfully achieved.
- Assist Nurse Supervisors and Manager with the management of workflow among nurses.
- Support and assist nurses with account-related questions related to appeals and denial resolution activities.
- Provide updates to Nurse Supervisors and Manager regarding client communication, updates, issues, and need.
- Provide Nurse Supervisors and Manager with information regarding staffing and personnel issues.
- Assist Nurse Supervisors and Manager in processing and developing client, payor, and company reports.
- Support the Nurse Supervisors, Manager, and nurses with managing and updating department work plans when applicable.
- Prepare and submit correspondence such as appeal letters, emails, online inquiries, reports as needed.
- Build strong, lasting relationships with clients and Revecore personnel.
- Attend client, department, and company meetings.
- Comply with federal and state laws, company policies, and procedures.
- Other duties as assigned.
Education/Licensing/Certifications - College degree or diploma from school of nursing - must be a licensed RN.
Work Experience & Skills - Minimum 5 years of denials and appeals experience and/or hospital revenue cycle experience.
- Experience with MCG, InterQual, NCD/LCDs, payor medical policies, and reimbursement policies.
- Clinical nursing experience working in hospital environment, preferably in ER, ICU, Med-Surg or Transplant unit.
- Moderate computer proficiency, including working knowledge of Microsoft Word, Power Point, Excel, and PDF files.
- Excellent interpersonal and communication skills.
- Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division.
- Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form.
- Ability to write routine correspondence (in English).
- Strong customer service orientation.
- Strong team player.
- Commitment to company values.
Work at Home Requirements:
• A quiet, distraction-free environment to work from in your home.
• A secure home internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads is required.
• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.
Must reside in the United States within one of the states listed below:
Alabama, Arkansas, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and West Virginia
