Denials Specialist Utilization Review(RN)

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence. The Denials Specialist-Utilization Review responsibilities include: Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members. Maintains and coordinates a timely appeal process or effectuates a correction of billing status. Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership. Position details: Location: Tampa or St Petersburg for up to first 6 months and then Remote Status: Full time, 40 hours per week Schedule: Monday - Friday 7:00 AM - 3:30 PM Weekend Requirement: None On Call: No Certifications and Licensure: Required RN License Preferred Accredited Case Manager Certification Preferred Certified Case Manager Education and Experience: Required Associate Degree in Nursing and 4 years Utilization Review, Managed Care or Finance OR Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance Preferred Masters Degree in Nursing Preferred 2 years Case Management Preferred 6 months Denials Management Preferred 1 year Medicaid/Medicare experience Benefits: Benefits (Health, Dental, Vision) Paid time off Tuition reimbursement 401k match and additional yearly contribution Yearly performance appraisals and team award bonus Community discounts and more Equal Opportunity Employer Veterans/Disabled Apply To this Job Company : BayCare Health System Salary : Work from home .