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Clinical Appeals & CDI Manager

Managed Resources

Remote, CA(remote)

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JOB DETAILS
SKILLS
Clinical Data, Clinical Nursing, Clinical Validation, Communication Skills, Content Development, Data Collection, Diagnosis-Related Group (DRG), Financial Trend Analysis, Microsoft Office, Nursing, Performance Analysis, Performance Reviews, Presentation/Verbal Skills, Registered Nurse (RN), Resource Management, Skype, Writing Skills
LOCATION
Remote, CA
POSTED
30+ days ago

Purpose: 

 

The Clinical Appeals & CDI Manager will work in conjunction with the Director of Clinical Appeals to oversee the various functions of the Clinical Appeals Department for Managed Resources, Inc.  The Manager’s responsibilities include review of appeal letters according to established company parameters, assists in quarterly audit reviews of nurses with the Director of Clinical Appeals, assists with quarterly reports for clients and attends meetings as needed, attend management meetings as needed via Skype, coordinates staff meetings with the Director, maintains a work queue of assignments, and other duties as needed if Director is unavailable.  

Reports to:  

Director of Clinical Appeals 

 
Essential Job Functions: 

Complete the following functions in accordance with Managed Resources policies: 

  • The Clinical Appeals & CDI Manager will report directly to the Director of Clinical Appeals. 

  • Reviews clinical appeal letters as designated by the Director of Clinical Appeals.  

  • Assists Clinical Appeal Nurses as needed with questions, research, etc. 

  • Assists Director with nurse audits as needed on a quarterly basis. 

  • Assists with nurse assignments of client projects. 

  • Ensure employee compliance with HIPAA regulations/training as required. 

  • Assists the Director of Clinical Appeals with data gathering for month end and quarterly reports as needed. 

  • Attends client meetings as needed and/or required. 

  • Assists with reviewing appeal letters as necessary. 

  • Provides input on content and direction of staff meetings.  

  • Assists with yearly performance evaluations of Clinical Appeal Nurses. 

  • Maintains personal work queue. 

Education and Experience: 

 

  • Registered Nurse (BSN preferred) or Physician, Previous management experience preferred 

  • CCS; CDIP and/or CCDS preferred 

  • Clinical Documentation Improvement (CDI) experience  

  • DRG and Coding Appeal writing experience  

  • Knowledge of CMS rules and regulations and third party payer requirements for reimbursable care 

  • Excellent written and oral communication skills 

  • Proficient in Microsoft Office 

Ideal candidate will possess the following: 
 

  • Ability to examine financial and clinical data trends and provide recommended action plan.  

  • Integrity and commitment to excellence.  

About the Company

M

Managed Resources