Position Summary

This position provides comprehensive assessment, coordination, implementation and reporting of complex clinical data. This position audits medical records on behalf of hospital clients for denials review, defense audits, disallowed charges and retrospective or concurrent reviews. The Supervisor NA, leads and supports the enterprise in utilization management through denials prevention and denials management. The Supervisor, NA brings expert analysis of medical records to inpatient and outpatient claims, assesses the patient’s plan of care and progress of the patient throughout an acute care admission. The intensity of assessment is situational and appropriate based on payer requirements. This position works independently receiving supervision of work activities from the Manager Case Manager. This position supervises and oversees denial management team and collectors on operational changes, quality improvement and staff development across the enterprise.

Education

• Bachelors degree in Nursing or a combination of Associate degree in Nursing coupled with 3 years clinical experience. (Required)
• Masters degree in Nursing (Preferred)

Experience

• Minimum of five years of broad clinical experience, predominately in pediatric care. Care coordination, case management, discharge planning and utilization review experience preferred. (Required)
• Working knowledge of the financial aspects of third party payers and reimbursement. (Required)

Certifications

• Current State of Arizona RN license. (Required)
• Current BLS certification for Health care Provider from the American Heart Association. (Required)
• Valid AZ Department of Public Safety (DPS) Fingerprint Clearance Card (Required)
• Case Management Certification (CCM) (Preferred)

Special Skills

• Knowledge of Milliman Criteria (Required)
• Excellent communication skills, both verbal and written. (Required)
• Effective decision-making /problem solving skills, demonstration of creativity in problem-solving, influential leadership skills. (Required)
• Critical thinking skills. (Required)
• Moderate to expert computer skills. (Required)