UR/TOC & Denials RN

Job Summary

• Clinical Analysis, Data Management and Denial prevention
• Responsible for compiling an appropriate appeal response to commercial and/or government appeal response to commercial and/or government payer regarding denial and/or audit, including follow up of appeals throughout process for resolution and reporting.
• Utilization Review, Utilization Management, Advocacy and Education
• Responsible for review of concurrent denial/reimbursement from commercial and/or government payers for inpatient and outpatient.

Qualifications

Education

• Bachelor of Science in Nursing (BSN) or Masters of Science in Nursing (MSN) preferred, Associate degree of Nursing (A.D.N.) required.

Experience

• Minimum of three years of experience in acute care patient setting. 
• Minimum of one year experience in Clinical Documentation or Appeal/Denial Management experience preferred. 
• Utilization Review or Case Management experience preferred.

Licensure/Certification/Registration/ETC.

• Current OK RN license required.  Basic Life Support (BLS) training or retraining is required and must be maintained for the duration of employment.

Compensation/Benefits

• $30.10-$49.17/hr depending on previous work experience.
• Benefits include medical, dental, vision, short-term disability, long-term disability, life insurance, paid time off (PTO), paid holidays, tuition reimbursement, scholarship opportunities, retirement plans, free parking, and opportunities for advancement.

Work Shift

Day
Position Type

Regular Full Time

Education

• Bachelor of Science in Nursing (BSN) or Masters of Science in Nursing (MSN) preferred, Associate degree of Nursing (A.D.N.) required.

Experience

• Minimum of three years of experience in acute care patient setting. 
• Minimum of one year experience in Clinical Documentation or Appeal/Denial Management experience preferred. 
• Utilization Review or Case Management experience preferred.

Licensure/Certification/Registration/ETC.

• Current OK RN license required.  Basic Life Support (BLS) training or retraining is required and must be maintained for the duration of employment.

Compensation/Benefits

• $30.10-$49.17/hr depending on previous work experience.
• Benefits include medical, dental, vision, short-term disability, long-term disability, life insurance, paid time off (PTO), paid holidays, tuition reimbursement, scholarship opportunities, retirement plans, free parking, and opportunities for advancement.

• Clinical Analysis, Data Management and Denial prevention
• Responsible for compiling an appropriate appeal response to commercial and/or government appeal response to commercial and/or government payer regarding denial and/or audit, including follow up of appeals throughout process for resolution and reporting.
• Utilization Review, Utilization Management, Advocacy and Education
• Responsible for review of concurrent denial/reimbursement from commercial and/or government payers for inpatient and outpatient.