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Manager Denials and Utilization Review - Santa Barbara, CA

Quick Facts
Company Name:Cottage Health
Location:Santa Barbara, CA
Employment Type:Full Time
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Description

Organization Overview:

For over 125 years, Cottage Health a not-for-profit health system, located on the beautiful Central Coast of California has been providing advanced medical care for patients throughout state. Today, our nationally recognized services provide families with the patient-centered care they deserve. At Cottage Health, we rely on the contributions, creativity and skills of our remarkable staff. That's why we offer competitive compensation and benefits that include above-market salaries, premium medical coverage, pension plans, tax savings accounts, rental and relocation assistance, and mortgage assistance.

Location:

Nestled between the ocean and the mountains, Santa Barbara, California offers breath-taking vistas, beautiful flowers, an abundance of Spanish colonial architecture and a mild, "Mediterranean" climate. Santa Barbara offers the feel of a quant beach town, but has all amenities you would expect from a larger city. Once you come home to Santa Barbara, it's hard to imagine living anywhere else.

Job Summary:

Cottage Health has an amazing opportunity for a talented Denials and Utilization Review Nurse to manage denials and appeals between Cottage Health and outside payers. The incumbent will join a highly skilled cohort of Revenue Cycle professionals that thrive on challenges and collaboration, and have a passion for solving challenges by leveraging cutting edge technology.   

The incumbent, under direction of the Director of Revenue Integrity, will actively maintain and manage denials and communicate appeals activities to stakeholders, to include wins/partial wins/losses, cases that are being appealed based on chart documentation/support and cases pending review. Incumbent will also identify and report on the categorization of denials, suspected or emerging trends related to payer denials and/or slow payment, and lead action planning for correction and process changes to eliminate avoidable denials. The Manager will also serve as an active member of the Utilization Review Committee.

 Qualifications:

  • Bachelor's degree in Business, Accounting, Finance, Nursing, or other related field.
  • Current nursing license in good standing. If not an active California nursing license, would need to become certified in California upon hire. 
  • Must be able to demonstrate an understanding of InterQual and Milliman guidelines, community standards relevant to inpatient acute care, and payer denial and appeal processes.
  • Must be able to exercise independent discretion and judgement, and act at all times with the highest degree of professionalism and objectivity.
  • Must be computer literate and able to manage Outlook, Word and Excel programs, prepare charts and graphs, and analyze data to identify trends and opportunities for process improvement.
  • Knowledge of various spreadsheet applications, including Microsoft Word.  Knowledge of billing requirements related to charges.  
  • Two years direct patient care experience as an RN in an acute care setting. Three years of experience working with denials and appeals, utilization review, and case management in an acute care setting. Two years supervisory experience.

 

  Additional Desired/Preferred Qualifications:

  • Certification in case management preferred.

 

With our amazing culture, a multitude of accolades and location, this is an amazing place to work! Life. Where you love it.  : http://lifewhereyouloveit.org/core-values.html

 

Make the move that will change your career!

Please apply online: www.cottagehealthsystem.org

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