Job Description

Shift: Fulltime Days. M-F 8:00am-5:00pm

Pre-Employment Requirements:

• We are a drug free facility. Passing a pre-employment drug screening is required

Position goal:

• Responsible for influencing positive clinical and financial outcomes of a designated caseload of patients.
• Responsible for timely entry, follow-up and management of appeals according to payer rules.
• Writes appeal letters addressing the reason for denial with clinical data to support appeal.
• Communicates with all parties involved in the denial process, including but not limited to, BO, Case Management, Payers, HIM.

Education Requirements

Applicant must be an LPN/RN or Social Worker.

• Nurse Requirements:
  • Graduate from an accredited school of nursing.
  • LPN or RN license required.
  • Current licensure in the State of Alabama is required.
  • Bachelors of Science in Nursing preferred.
• Social Worker Requirements:
  • Graduate from an accredited school of Social Work.
  • Current licensure in the State of Alabama required.

Experience:

• Minimum of one year of Case Management and/or Discharge Planning experience required.
• Clinical nursing experience.
• Must demonstrate critical thinking skills and decision making ability.
• Demonstrates the ability to carry out detailed written or verbal instructions independently.
• Working Knowledge of Microsoft Office (Word, Excel, and PowerPoint)