At Virtua Health we exist for one reason to better serve you.That means being here for you in all the moments that matter striving each day to connect you to the care you need.Whether thats wellness and prevention experienced specialists life-changing care or something in-between we are your partner in health devoted to building a healthier community.If you live or work in South Jersey exceptional care is all around.Our medical and surgical experts are among the best in the country.We assembled more than 14000 colleagues including over 2850 skilled and compassionate doctors physician assistants and nurse practitioners equipped with the latest technologies treatments and techniques to provide exceptional care close to home.A Magnet-recognized health system ranked by U.S.News and World Report weve received multiple awards for quality safety and outstanding work environment.In addition to five hospitals seven emergency departments seven urgent care centers and more than 280 other locations were committed to the well-being of the community.That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program telehealth home health rehabilitation mobile screenings paramedic programs and convenient online scheduling.Were also affiliated with Penn Medicine for cancer and neurosciences and the Childrens Hospital of Philadelphia for pediatrics.Location :Pennsauken - 6991 North Park Dr.Remote Type :100% RemoteEmployment Type :EmployeeEmployment Classification :RegularTime Type :Part timeWork Shift :1st Shift (United States of America)Total Weekly Hours :20Additional Locations :Job Information :Remote work environment after successful completion of in-office trainingSummary :Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes.Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process.Position Responsibilities :Utilization ManagementUtilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.Consults with Physician Advisor to discuss medical necessity length of stay and appropriateness of care issues.Identify and manage concurrent and retroactive denials through communication with attending physicians case management multidisciplinary team external physician resource group and payers.DocumentationAppropriate and complete documentation of clinical review and denial management in the case management documentation system and in the billing system.Denial ManagementManages the concurrent denial process by referring to appropriate resource for concurrent and retrospective appeal activity process.Prepares and facilitates audits using appropriate screening tools and documentation.MetricsAccountable to job specific goals objectives and dashboards which contribute to the success of the organization.Participates in organizational improvement activities including patient satisfaction Six Sigma committee department and / or divisional teams and community activities.ComplianceUnderstands and applies applicable federal and state requirement.Identify and reports compliance issues as appropriate.Position Qualifications Required / Experience Required :RN required.3 years clinical nursing (RN) experience and 1 year UR / CM / QM experience preferred.Basic understanding of Medicare Medicaid and managed care.Discharge planning or home health background.Excellent verbal and written communication skills problem solving critical thinking and conflict resolution.Required Education :Graduate of an accredited School of Nursing BSN strongly preferred.Training / Certifications / Licensure :Licensure from the State of New Jersey as a Registered Nurse.Case Management Certification (requirement within one year of hire beginning April 1 2015).STAR Standards :Exhibits Virtuas STAR Standards to create an outstanding patient experience.(Excellent Service Clinical Quality and Safety Best People Caring Culture Resource Stewardship).Demonstrates Virtua values in all interactions with our customers who are patients families physicians co-workers and the community.(Integrity Respect Caring Commitment Teamwork Excellence).Annual Salary :$77405 - $123574 The actual salary / rate will vary based on applicants experience as well as internal equity and alignment with market data.Virtua offers a comprehensive package of benefits for full-time and part-time colleagues including but not limited to :medical / prescription dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off paid sick leave as provided under state and local paid sick leave laws short-term disability and optional long-term disability colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance and an employee assistance program that includes free counseling sessions.Eligibility for benefits is governed by the applicable plan documents and policies.For more benefits information click here.Required Experience :ManagerKey SkillsBidding,Apps,Benefits,Corporate Recruitment,Android DevelopmentExperience :yearsVacancy :1. Experience: 3 years required