RN Supervisor, Clinical Medical Appeals- Care Management Program - Providence Health & Services - Olympia, WA

RN Supervisor, Clinical Medical Appeals- Care Management Program - Providence Health & Services - Olympia, WA -

**Description: **

**Providence is looking a Registered Nurse Supervisor, Clinical Medical Appeals for the Care Management Program at Providence St. Peter Hospital in Olympia, WA.**

The Supervisor supplies oversight of the day-to- day operations for Clinical Medical Appeals employees and particular transition of care actions, comparable to discharge comply with-up telephone calls. This place studies to the Providence Southwest Area Director of Care Management.

**This can be a full-time, dayshift exempt degree place.**

**On this place you’ll: **

+ Present help to the processes of interesting hospital claims which have been denied based mostly on medical want

+ Work intently with Providence RBO (Regional Enterprise Workplace) account representatives and the ORC (One Income Cycle) denial staff to resolve SWR medical declare cost points

+ Helps hospital / medical employees to resolve declare points, concurrently and retrospectively, with facilitation with insurance carriers, schooling to stop denials by way of medical and documentation course of enhancements, and producing development and element declare denial stories

+ Evaluate medical data utilizing proof based mostly medical standards, i.e., Interqual, to correct symbolize the severity of sickness. This includes in depth every day document assessment, interplay with physicians, HIM professionals, management, nursing employees, RBO and ORC declare employees together with exterior representatives for well being insurance

**Qualifications: **

**Required qualifications for this place embrace: **

+ Commencement from an accredited program of nursing

+ Licensed as a Registered Nurse

+ Three to 5 years of acute care (hospital) expertise

+ An in-depth information of medical points and affected person care practices

+ Proficiency in talking studying, and writing English

+ Possess robust workforce constructing and battle management expertise

+ Exhibit crucial considering, drawback fixing and deductive reasoning expertise

+ Educated of Pathophysiology and Illness Course of

+ Information of or willingness to study utilization assessment, well being insurance ideas, and case management because it pertains to well being care supply and compliance/regulatory surroundings for billing

+ Should be capable of categorical self clearly, utilizing medical phrases, for exterior correspondence

**Most popular qualifications for this place embrace: **

+ Bachelor’s Diploma in Nursing

+ RN expertise in Essential Care, Telemetry, Emergency Division, or robust Medical/Surgical RN expertise

**Concerning the hospital you’ll serve: **

Providence St. Peter Hospital is a 390-bed, not-for-revenue regional educating hospital. Situated in Olympia, WA, St. Peter presents complete rehabilitation, medical, surgical and behavioral well being providers. We now have been ranked as one of many prime 100 hospitals and as certainly one of 10 premier healthcare employers within the nation and have just lately achieved the coveted Magnet®” recognition from the American Nurses Credentialing Middle®. Our hospital rests on a 173-acre campus, a lot of which incorporates pure forest and preserved wetlands that keep a therapeutic surroundings for sufferers and employees.

**We provide a full complete vary of advantages – see our web site for particulars**

http://www.providenceiscalling.jobs/rewards-benefits/

**Our Mission**

As individuals of Providence, we reveal God’s love for all, particularly the poor and weak, by means of our compassionate service.

**About Us**

Providence Health & Services is the third largest not-for-revenue well being system in the USA. Providence employs greater than 76,000 caregivers (staff) throughout a 5-state space; AK, WA, MT, OR, and CA. Our amenities embrace 34 hospitals, 475 doctor clinics, senior providers, supportive housing and different well being and academic providers. Providence is proud to be an Equal Alternative Employer. Providence doesn’t discriminate on the idea of race, colour, gender, incapacity, veteran, army standing, faith, age, creed, nationwide origin, sexual id or expression, sexual orientation, marital standing, genetic info, or another foundation prohibited by native, state, or federal regulation.

**Schedule: ** Full-time

**Shift: ** Day

**Job Class: ** High quality Nursing

**Location: ** Washington-Olympia

**Req ID: ** 135690

APPLY THIS JOB HERE

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