Progressive IT RN Supervisor-Clinical Appeals/ Pre-Certifications in Nashville, Tennessee
RN Supervisor-Clinical Appeals/ Pre-Certifications
We are looking for a nurse, located in Nashville to be a supervisory lead over pre-certifications, clinical appeals and grievances. This person should have extensive Medicare Part C experience, supervisory experience and the experience to work with other consultants and the end client.
RN must have experience with managed care, utilization management, appeals or Medicare
Works to close clinical and pharmacy gaps and to mitigate non-clinical barriers to care
Registered Nurse Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions
Completes and files all assessments
Manages own caseloads and coordinates all assigned cases
Must have current licensure as a Registered Nurse (RN) in State of residency. Must be able to use computer system.
Excellent communication and interpersonal skills. Excellent time management, organization and negotiation skills. Ability to assess complex issues, recommend changes and resolve problems
Must have lead or supervisory Experience over pre-certifications, clinical appeals, and grievances.