Clinical Financial Case Manager - RN

Responsibilities

• Secure complex pre-authorizations and prevent or appeal clinical denials
• Interpret medical necessity guidelines to determine appropriateness for services
• Make determinations on appropriate levels of care (Inpatient vs Observation)
• Act as Subject Matter Expert for assigned payers and governmental requirements
• Maintain awareness of healthcare trends, JCAHO, CMS, and third-party payer guidelines
• Analyze payer remits, denial codes, and expected reimbursement to determine appeal cost-effectiveness

Requirements

• Bachelor's degree in nursing with current license
• Minimum of 3 years clinical care experience
• Experience collaborating with physicians and designees
• Strong analytical and decision-making skills
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Teams) and Adobe Professional
• Ability to manage complexities across multiple applications like IHIS and 3M

Benefits

• Medical, dental, and vision coverage with significant employer contribution
• Paid time off including sick time, vacation time, and 11 holidays
• State retirement plan or alternative retirement plan with generous employer contributions

About the Company

The Ohio State University Wexner Medical Center is part of a top-20 public university and one of America's leading academic health centers, committed to excellence in education, research, and healthcare.