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Change Healthcare Clinical Denial/Utilization Review Nurse-RN/BSN in Miami, Florida

Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life. If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare.

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.

Clinical Denials-Utilization Review NurseOverview of PositionThe Clinical Denial Utilization Review Nurse is responsible for conducting clinical reviews to justify and dispute payer denials. The role will develop case studies, coordinate with hospital operations and payers to ensure optimal results in denial prevention. The clinical denial coordinator will oversee quality assurance for clinical denials, including development of protocol and training. This position will be onsite at our client site in Miami, Florida.

What will be my duties and responsibilities in this job?

  • Provide clinical argument, using available Medical Records, to justify and dispute payer denials, all levels of appeals included.

  • Develop monthly case studies, identifying payer and hospital operational opportunities

  • Compile reports as requesting by the ROS client and operations, specific to payers, operations and clinical reviews

  • Participate in performance meetings as requested by ROS client and operations

  • Develop and conduct quality reviews of all clinical reviews, including training.

What are the requirements needed for this position?

  • 5+ years Utilization Review or Case Management nursing experience

  • Extensive knowledge in evidence-based protocols– Hospital Case Management such as Milliman and/or Interqual guidelines

  • Experience analyzing data and presenting those findings to both leadership and operational teams

  • Strong experience utilizing Microsoft Office applications to include: Excel, Word, and PowerPoint

  • BSN or RN required

  • Current valid State of Florida or multi state license as a Registered Nurse

What are the working conditions and physical requirements of this job?

General office demands

How much should I expect to travel?

Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.

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