Revenue Cycle Nurse Manager- Clinical Appeals
You were meant for Hopkins! Come see why the Johns Hopkins Hospital is a world-renowned leader in patient care, serving the greater Baltimore community and patients from all across the globe. Our friendly and knowledgeable staff teams provide support throughout our many specialty departments and centers, from primary visits to emergency care.
What Awaits You?
ā¢ Career growth and development
ā¢ Diverse and collaborative working environment
ā¢ Affordable and comprehensive benefits package including Tuition Reimbursement
The Revenue Cycle Manager of Clinical Audit and Administrative Appeals is responsible for the development and management of programs related to regulatory reimbursement, including but not limited to the oversight of the Recovery Audit Contractor implementation and Medicaid Integrity Project, and the denial and appeal processes for emergency, outpatient, and inpatient encounters as performed by the Nurses and Claims Analysts for the JHH, JHBMC, HCGH, SMH, SH and ACH. The Manager also has direct responsibility for the Outsource Nurse, Administrative Coordinator and Staff Assistant processes that support RCM and the denial and appeal processes. This position reports directly to the Director of Appeals and Revenue Integrity and provides support for Payor Management and implements the organization's regulatory reimbursement management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, payer requirements and accreditation standards. The Manager also provides other JHM entities support in project planning and implementation along with supervising and recruiting departmental registered nurses.
Hours:
Full time (40 hours)
Day Shift, Weekdays
Location:
Remote- Requires current Registered Nurse Licensure in the State of Maryland.
Qualifications:
ā¢ Bachelor's Degree or Associate Degree in Nursing from an accredited School of Nursing.
ā¢ Requires current Registered Nurse Licensure in the State of Maryland.
ā¢ 15 years of direct management experience in an academic health system.
ā¢ Excellent knowledge base related to nursing and reimbursement practices, financial and data analysis, third party payer regulations, utilization management standards, case management methodologies, age specific and other regulatory and accreditation requirements related to Care Coordination and cost containment.
Our competitive Benefit Package is designed to support the well-being and financial security of our employees and includes:
ā¢ Full medical, dental, and vision plans,
ā¢ Retirement plans,
ā¢ Paid time off (PTO),
ā¢ Tuition reimbursement for you and your dependents,
ā¢ Tell a friend and get paid! Ask about our Employee Referral Program Bonus!
ā¢ And more! Visit https://jhh.mybenefitsjhhs.com/
Salary Range: Minimum 48.32/hour - Maximum 74.90/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
What Awaits You?
ā¢ Career growth and development
ā¢ Diverse and collaborative working environment
ā¢ Affordable and comprehensive benefits package including Tuition Reimbursement
The Revenue Cycle Manager of Clinical Audit and Administrative Appeals is responsible for the development and management of programs related to regulatory reimbursement, including but not limited to the oversight of the Recovery Audit Contractor implementation and Medicaid Integrity Project, and the denial and appeal processes for emergency, outpatient, and inpatient encounters as performed by the Nurses and Claims Analysts for the JHH, JHBMC, HCGH, SMH, SH and ACH. The Manager also has direct responsibility for the Outsource Nurse, Administrative Coordinator and Staff Assistant processes that support RCM and the denial and appeal processes. This position reports directly to the Director of Appeals and Revenue Integrity and provides support for Payor Management and implements the organization's regulatory reimbursement management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, payer requirements and accreditation standards. The Manager also provides other JHM entities support in project planning and implementation along with supervising and recruiting departmental registered nurses.
Hours:
Full time (40 hours)
Day Shift, Weekdays
Location:
Remote- Requires current Registered Nurse Licensure in the State of Maryland.
Qualifications:
ā¢ Bachelor's Degree or Associate Degree in Nursing from an accredited School of Nursing.
ā¢ Requires current Registered Nurse Licensure in the State of Maryland.
ā¢ 15 years of direct management experience in an academic health system.
ā¢ Excellent knowledge base related to nursing and reimbursement practices, financial and data analysis, third party payer regulations, utilization management standards, case management methodologies, age specific and other regulatory and accreditation requirements related to Care Coordination and cost containment.
Our competitive Benefit Package is designed to support the well-being and financial security of our employees and includes:
ā¢ Full medical, dental, and vision plans,
ā¢ Retirement plans,
ā¢ Paid time off (PTO),
ā¢ Tuition reimbursement for you and your dependents,
ā¢ Tell a friend and get paid! Ask about our Employee Referral Program Bonus!
ā¢ And more! Visit https://jhh.mybenefitsjhhs.com/
Salary Range: Minimum 48.32/hour - Maximum 74.90/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.