APPEALS RN

Qualifications: Education: Bachelors of Nursing (BSN) Preferred License/Certification: Accredited/Certified Case Manager (ACM or CCM) designation strongly preferred Registered Nurse (RN) required Experience: Two years of acute care, utilization management, or payer experience required Ability to function autonomously maintaining a high level of clinical and professional accountability Demonstrates skill in creative problem solving, facilitation, collaboration, coordination and critical thinking Embraces change and continuously identifies opportunities for improvement by demonstrating a commitment to creativity and innovation Committed to promoting excellence in Customer Service; functions as a team player Computer literacy and data analysis skills are required Maintains professional image by demonstrating strong verbal and written communication skills Demonstrates ability in self-starting, self-directing and clear decision-making behaviors Position Summary: Works in collaboration with the physician and interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care and promoting clinical best practice. Ensuring all patients receive the right care, the right cost, right time, and in the right setting. Salary Range: $24.72 - $39.01 Columbia Memorial Health is an Equal Opportunity/Affirmative Action Employer.

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