RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey, with a service area covering five million people. The system includes eleven acute care hospitals - Clara Maass Medical Center in Belleville, Community Medical Center in Toms River, Jersey City Medical Center in Jersey City, Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood, Newark Beth Israel Medical Center in Newark, RWJUH- New Brunswick, RWJUH- Somerset in Somerville, RWJUH- Hamilton, RWJUH- Rahway and Saint Barnabas Medical Center in Livingston; three acute care children's hospitals and a leading pediatric rehabilitation hospital (Children's Specialized Hospital), a freestanding 100-bed behavioral health center, trauma centers, a satellite emergency department, ambulatory care centers, geriatric centers, the state's largest behavioral health network, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy services, a medical group, multi-site imaging centers and an accountable care organization.
RWJBarnabas Health is New Jersey's largest private employer - with more than 33,000 employees, 9,000 physicians and 1,000 residents and interns - and routinely captures national awards for outstanding quality and safety.
Our Denial Management Recovery Services division is an integral part of our company's success. The RN of Appeals within the RWJ Barnabas healthcare facilities is responsible for managing medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Where warranted, the RN will write sound, compelling factual arguments correspondence. He/she will construct and document a succinct and fact based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.
Core duties and responsibilities include the following:
Minimum Qualifications & Competencies:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
We offer a great work environment, competitive rates and excellent benefits, including: