Denials Management RN

Job Summary and Responsibilities

As a Denials Management Professional, you will provide critical expertise in revenue cycle optimization, meticulously recovering rightful reimbursements and enhancing financial stability.

Every day you will expertly analyze denied claims, identify root causes, appeal rejections, and meticulously collaborate with various departments to implement corrective actions and improve future claims submission processes.

To be successful, you will demonstrate outstanding analytical skills, strong communication abilities, and a persistent, detail-oriented demeanor, contributing significantly to revenue integrity and a healthy financial outlook.

• Facilitates coordination of a multidisciplinary plan of care to guide patient progress to promote the achievement of optimal clinical, quality, and cost effective outcomes.
• Collaborates with physician and multidisciplinary team in identifying appropriate patients for care management review, utilizing established care management criteria.
• Assesses, plans, and coordinates care on select patient population.
• Seeks and evaluates available options and services to meet an individual’s health needs and care team recommendations.
• Promotes patient self-management and empowers patient/families to achieve optimal levels of wellness and independence.
• Collaborates with the healthcare team members at hospitals, clinics, residential care facilities or other settings, and health insurance payers to facilitate care across the continuum and optimize clinical and financial outcomes.

Job Requirements

Required

• Graduation from an accredited school of nursing and (3) three years of recent clinical work experience in the specialty area or related clinical specialty in a hospital setting within the past five years that demonstrates attainment of the requisite job knowledge skills/abilities., upon hire and
• Registered Nurse: WA, upon hire

Preferred

• Experience with utilization management, discharge planning and/or case management
• Accredited Case Manager, upon hire or
• Case Management Nurse, upon hire or
• Certified Case Manager, upon hire or
• Psychiatric and Mental Health Nurse, upon hire

Where You'll Work

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.

Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person – body, mind, and spirit – in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.

Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.

We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.