RN Recovery Nurse Appeals Specialist - Revenue Cycle - Remote

Overview

The RN Recovery Nurse Appeals Specialist at Ochsner Health is responsible for applying clinical expertise and knowledge of utilization and discharge planning criteria to review medical information for prior hospitalized patients, ensuring compliance with regulations and optimizing financial reimbursement.

In Short

• Conduct medical necessity audits for prior hospitalized patients.
• Identify issues affecting patient care and hospital resource utilization.
• Serve as a liaison with the Vice President/Manager of Regulatory Audits.
• Maintain compliance with federal and state regulations.
• Review denial and informational requests from regulatory agencies.
• Coordinate medical necessity reviews with other team members.
• Adapt communication style to various patient populations.
• Ensure minimum standards for licensure and professional development.
• Work independently and as part of a team in high-pressure situations.
• Perform other related duties as required.

Requirements

• Current State of Louisiana Registered Nurse (RN) License.
• 3 years of hospital-based experience as an RN.
• Experience in Case Management, Utilization Review, or Discharge Planning.
• Certification in Case Management or Utilization Review preferred.
• Strong computer skills for data entry and retrieval.
• Effective verbal and written communication skills.
• Ability to present information clearly to various stakeholders.
• Strong financial skills for evaluating medical necessity.
• Ability to work flexible hours, including weekends and holidays.
• Ability to handle exposure to communicable diseases.

Benefits

• Competitive salary and benefits package.
• Opportunity for professional development and growth.
• Work in a supportive and innovative healthcare environment.
• Recognition as a leading not-for-profit healthcare provider.
• Engagement in community health initiatives.
• Access to comprehensive health and wellness programs.
• Employee engagement and feedback opportunities.
• Flexible work schedule options.
• Supportive workplace culture focused on diversity and inclusion.
• Access to employee assistance programs.