Denials Specialist RN - Utilization Review

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

The Denials Specialist-Utilization Review responsibilities include: Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members. Maintains and coordinates a timely appeal process or effectuates a correction of billing status.

Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership. Position details: Location: Hybrid - Tampa/St Petersburg Status: Full time, 40 hours per week.

Exempt

Monday - Friday 7:00 AM - 3:30 PM(can be flexible) Weekend Requirement: Occasional On Call: No Certifications and

Required RN License Preferred Accredited Case Manager Certification Preferred Certified Case Manager Education and

Required 4 years RN experience with ASN and 2 years RN experience with BSN Required 2 years Utilization Review OR Care Coordination/Case Management OR Managed Care OR Finance experience Preferred Masters Degree in Nursing Preferred 6 months Denials Management Preferred 1 year Medicaid/Medicare experience

Benefits (Health, Dental, Vision) Paid time off Tuition reimbursement 401k match and additional yearly contribution Yearly performance appraisals and team award bonus Community discounts and more Equal Opportunity Employer Veterans/Disabled