Appeals Denial Nurse (RN) in Salisbury, Maryland at TidalHealth

Why work at TidalHealth?

Join a triple 'A' rated team where clinical excellence meets a coastal lifestyle. At TidalHealth, you’ll be part of an award-winning network spanning Maryland and Delaware, recognized by the Leapfrog Hospital Safety Guide for our unwavering commitment to patient care. Whether your expertise lies in specialized clinical fields like neurosurgery, academic mentorship through our graduate medical programs, or the critical professional and support roles that keep our network thriving, we provide the tools and tuition assistance you need to excel.

Appeals Denial Nurse (RN) Position Summary

The Clinical Denial Appeals RN is a Registered Nurse who is responsible for reviewing all post-billed clinical denials for medical necessity and appealing based upon clinical expertise and clinical judgment within the hospital system revenue operations. This RN is responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second and subsequent levels of appeal and ensuing timely filing of appeals as required by payers. Acts as the key information and education resource for the interdisciplinary team. Works to develop organization-wide approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all service team members, patients, and families. Works with the leadership team to align the goals and visions. It is essential for RN to have general knowledge of payor industry, resource management and evidence-based clinical practice. Theoretical knowledge of the nursing and case management processes. This candidate will demonstrate the ability to locate, research, comprehend and appropriately apply 3rd party payer rules and regulations to case reviews. This will require staying current with payor policy changes and communicating relevant information to key stakeholders in the denials and appeals process.

Appeals Denial Nurse (RN) Position Requirements

Education

• Graduate from an accredited school of Nursing.

Experience

• Five (5) plus years of clinical and utilization review experience required.

Required License and/or Certification

• Must have a current RN license in the state of permanent residency.

Appeals Denial Nurse (RN) Benefits

Benefits: We provide a robust benefits suite for our eligible team members (36+ hours for 12-hour shifts; 37.5+ hours for standard shifts):

• Health: Medical (including HSA), Dental, Vision, & Prescription
• Wealth: Matching 403(b), Healthcare FSAs, & Dependent Care FSAs
• Growth: $5,000 Tuition Assistance & Certification support
• Balance: Generous PTO and Holidays, Onsite Child Care, Pet Insurance
• Income Protection & Leave: Employer-Paid Short-Term Disability, Paid Leave Program, & Long-Term Disability (LTD for FT)
• Life & Security: Employer-paid Life and additional voluntary benefits such as Accident, Critical Care, additional Life, and more