RN Manager Grievances & Appeals - Hybrid

Hospital system looking to bring on RN Manager Grievances & Appeals! Sign On Bonus and Relocation!

• Oversees and provides direction for Intake, Appeals (Clinical and Claims), Retrospective Review, Emergency Room Review, and Customer Service/Complaints/Grievances for all lines of business.
• Responsible for day to day oversight and management of Intake, Clinical Appeals, Claims Appeals, Complaints, Grievances and Intake functions.

Qualifications:

• Bachelor’s degree in Nursing Required
• Experience working in a Managed Care Organization with strong experience in Medicaid
• Specific Experience working with Grievances and Appeals (minimum of 3 years)
• 3-4 years in UM and 5-7 years of clinical experience in a hospital or medical setting
• 2 years of nursing leadership as a supervisor or assistant manager
• KSAs Proficiency
• CCM - Certified Case Manager Active Certified Case Manager (CCM) or CCM certification within 1 Year Required