REMOTE FULL TIME PACIFIC - Clinical Appropriate Management Specialist
Location: Las Vegas, Nevada
Internal Number: 469802
What makesÂ Kindred HealthcareÂ a great place to work? Our people, of course! OurÂ cliniciansÂ answer this special calling because they have a fundamental, internal drive to directly help people. In return, we serve, develop and respect our employees in environments created to optimize theirÂ jobÂ effectiveness, experience, and satisfaction.Â This is who we are.
Who are you?Â To succeed in our high-energy, high-reward environment, ourÂ clinicians provide compassionateÂ critical careÂ and deliver exceptionalÂ patient experiences, meaningful outcomes, and bonds for life.
As our most acute level of care,Â Kindredâ€™sÂ transitional care hospitals offer the sameÂ critical careÂ patients receive in a traditionalÂ hospitalÂ orÂ intensive care unit, but for an extended recovery period. OurÂ cliniciansÂ play a vital role in the recovery process forÂ chronic, critically ill and medically complex patients.
As an Authorization & Appeals Management NurseÂ you will:
Combine strong relationship building skills and clinical knowledge to manage the Authorization and Appeals Management process.
Responsible for investigating and processing appeal requests and authorizations.
Primary duties include review of prospective, retrospective or concurrent medical records of denied services for medical necessity, as well as processing authorizations.
Serves as a liaison with marketing, business office and administration of the facilities.
Coordinates the managed care determinations and distributes information to the marketing and admissions support staff across multiple markets.
Identifies information needed from the referring hospital to finalize the authorization.
As an Authorization & Appeals Management NurseÂ you will have:
Bachelor's degree in clinical area strongly preferred.
Healthcare professional licensureÂ required as Registered Nurse,Â LPN, Respiratory Therapist, Physical Therapist, Occupational Therapist or Social Worker.Â
Three yearsÂ healthcare experience.
Proven history of effective relationship management in a matrix reporting structure.