The Case Appeals Nurse manages the process of appealing clinical
denials and reviewing denials to the insurance provider.
- Must have a good understanding of reimbursement methodologies
- Must have demonstrated knowledge of industry trends in Managed
- Work requires familiarity working with contracts and payment
- Must have demonstrated expertise in insurance, managed care and
federal/ state coverage.
- Work requires a high level of problem solving skills.
- Must have working knowledge of utilization management, case
management and process improvement.
- Must have base knowledge of clinical coding and reimbursement
and/or claims management.
- Must have clear and concise writing skills.
- Work requires the ability to interpret and execute Bon Secours
policies and procedures.
4 years of direct experience in Denials, Utilization Management,
Case Management or any combination preferred. Must have clinical
knowledge and be able to interpret hospital medical documentation
(ie. EMR). Working knowledge and use of evidenced based guidelines.
New York State RN license required.
Bachelor's Degree in Nursing or Associate Degree in Nursing with
clinical specialty certification, Utilization Management or Case
Management experience as noted under experience may substitute
If applicable, the individual performing this job may reasonably
anticipate coming into contact with human blood and other
potentially infectious materials. Individuals in this position are
required to exercise universal precautions, use personal protective
equipment and devices, and learn the policies concerning infection
Good Samaritan Hospital
Good Samaritan Hospital in Suffern, NY, is a 286-bed hospital
providing emergency, medical, surgical, obstetrical/gynecological
and acute-care services to residents of Rockland and southern
Orange counties in New York; and northern Bergen County, NJ. The
hospital is home to a recognized cardiovascular program,
comprehensive cancer-treatment services, the area's leading Wound
and Hyperbaric Institute and outstanding maternal/child services
that includes a Children's Diagnostic Center. Good Samaritan
Hospital also provides social, psychiatric and substance-abuse
services and its certified home-care agency supports residents of
the Hudson Valley and beyond.
Due to a recent upgrade in our online applicant tracking system,
anyone who has previously applied for a position with Good
Samaritan Hospital will be required to reapply.
With this recent upgrade to our system, all previous
applications are no longer accessible by the WMCHealth Recruitment
Team. We apologize for the inconvenience, and we appreciate your
understanding during our efforts to upgrade our systems to be able
to provide a better candidate experience.