Supervisor Clinical Denials

WHAT YOU CAN EXPECT

• Maintain inter- and intra-departmental communications, special projects, programs, policies, and procedures as well as clinical denial services.

• Participate and educate team in performance improvement initiatives. Implement processes to satisfaction with those we are privileged to serve.

• Coordinate and maintain compliance with HFAP, state and federal agencies pertaining to Utilization/Denial management activities.

• Supervise direct reports and manage the performance of individuals through ongoing coaching, feedback, and development to motivate, engage and drive a high performing team.

• Make decisions for direct reports in assigned function and performs people management activities such as performance evaluations, disciplinary actions, staff planning, and interviews.

• Oversee the claim denial appeal process; ensure appeals are appropriately documented, routed and filed as well as ensures appeals are followed-up in a timely manner and second level escalations occur as necessary. Outsource cases to appropriate areas when needed. Update payor grids with most up to date information.

QUALIFICATIONS

• Bachelor's Degree in Nursing required

• Active Indiana RN license required

• 5 years of Nursing/Patient Care required

• 2 years of Clinical Denials or Utilization Management experience required

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.