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Case Manager - Appeals

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Job Snapshot
Location:
Two Stone Harbor Blvd.
Cape May Court House, NJ 08210 (map it!Map it! )
Employee Type:
Full-Time
Industry:
Healthcare - Health Services
Manages Others:
No
Job Type:
Health Care
Nurse
Education:
4 Year Degree
Experience:
At least 5 year(s)
Post Date:
11/6/2009
Contact Information
Contact:
Jean Marie Keich
Description Full-Time Position available.  Conducts detailed chart review and makes determination using parameters as to whether appeal is to be generated.  Prepares appeals for Recovery Audit contractor (RAC)/Diversified Collection Services process utilizing appropriate guidelines and/or criteria.  Works with Appeals Processor/Expeditor to document review and appeals outcomes in Audit Trax.  Screens potential admissions to determine medical necessity for admission vs. observation, or treat and discharge from the Emergency Department.  Works with Health Care Team to ensure patient on appropriate medical protocols.  Designs a thorough plan to meet outpatient needs.


Requirements RN licensed by the State of New Jersey with BSN, or certified case manager required.  Five years utilization or case management in hospital setting required.  Hospital discharge planning experience preferred.  Familiarity and knowledge of payor requirements.  Experience with RAC process, chart audit, and/or appeals determination and preparation preferred.
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