RN Clinical Denial Specialist

apartment Franciscan Health location_onMishawaka, IN 46544, US

Work From Home

Work From Home Work From Home, Indiana 46544

The Clinical Denial Specialist II functions as a hospital liaison to appeal denied claims for Medicare, Medicaid, Managed and Commercial insurance. This position entails detailed retrospective review via EPIC of patient medical records to analyze and compile data for additional documentation request and claim denials, using trends and patterns identified to support process improvement.

WHO WE ARE
With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

WHAT YOU CAN EXPECT

Schedule: Monday – Friday, 8am - 5pm
Develop reports
Review governmental contractor’s response
Identify underlying root causes for potential denials and works closely with departments and Clinical Documentation Integrity to reduce denials
Write and ensure all appeals are filed in a prompt and timely manner for Medicare, Medicaid, Managed, and Commercials Payor
Audit medical documentation for adherence to insurance and CMS guidelines relating to inpatient/observation services, or other denial issues
Knowledge of inpatient criteria to establish medical necessity letters

QUALIFICATIONS

Active Indiana RN license required
BSN or Associate's with 5 years of nursing experience required
3 years of denial experience required
5 years of nursing or case management experience preferred

TRAVEL IS REQUIRED:

Never or Rarely

JOB RANGE:

Clinical Denial Specialist II $52395.20-$77948.00

INCENTIVE:

Not Applicable

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Share this job

Related Jobs

Full-time

REGISTERED NURSE - NIGHT SHIFT 6:00 PM - 6:30 AM

apartment UHS location_onPlymouth, IN

Responsibilities Registered Nurse – Night Shift 6:00 p.m. - 6:30 a.m. Michiana Behavioral Health is dedicated to creating a therapeutic environment that helps patients restore their health and get a fresh start. Located in Plymouth, Indiana, in a rejuvenating wooded setting, Michiana Behavioral Health provides each patient with comprehensive behavioral health treatment from compassionate and caring staff. Our leadership is committed to making sure every patient in our care receives high-quality care that gets them back on track at school, work, and home. Benefits for Registered Nurse (RN) include: Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Psychiatric Nurse Residency Transition-to-Practice Program (Could earn 20 CEUs) Career development opportunities within UHS and its 300+ Subsidiaries! 12-Hour Shifts; Set Schedules Tuition Assistance Loan Forgiveness $10,000 Sign On Bonus for Full-Time If you would like to learn more about the Registered Nurse (RN) position before applying, please contact Becky Nowicki, Director Human Resources at becky.nowicki@uhsinc.com and by phone at 574-941-5717. What do our current nurses value at Michiana Behavioral Health & UHS? An environment that puts patient care first. One of the most rewarding aspects of working as a Registered Nurse (RN) is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. You are never alone, as you are part of a large network of peer nurses and nursing leaders that routinely exchange ideas and review current topics within the industry. Having the opportunity to grow, learn, and advance in your career. There are very robust continuing education options and opportunities for skills diversification and career advancement as a Registered Nurse (RN) with UHS. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Registered Nurse (RN) Job Requirements: Current license to practice nursing in the State of Indiana. Preferred one year of experience working in a psychiatric inpatient setting, however, willing to train the right individual that has a passion for children, adolescents, and adults with mental health and addiction disorders. Experience working with children and adolescents a plus. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Full-time

REGISTERED NURSE - DAY SHIFT

apartment UHS location_onPlymouth, IN

Responsibilities Registered Nurse – Day Shift – 6:00 a.m. – 6:30 p.m. Michiana Behavioral Health is dedicated to creating a therapeutic environment that helps patients restore their health and get a fresh start. Located in Plymouth, Indiana, in a rejuvenating wooded setting, Michiana Behavioral Health provides each patient with comprehensive behavioral health treatment from compassionate and caring staff. Our leadership is committed to making sure every patient in our care receives high-quality care that gets them back on track at school, work, and home. Benefits for Registered Nurse (RN) include: Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Psychiatric Nurse Residency Transition-to-Practice Program (Could earn 20 CEUs) Career development opportunities within UHS and its 300+ Subsidiaries! 12-Hour Shifts; Set Schedules Tuition Assistance Loan Forgiveness $10,000 Sign On Bonus for full-time If you would like to learn more about the Registered Nurse (RN) position before applying, please contact Becky Nowicki, Director Human Resources at becky.nowicki@uhsinc.com and by phone at 574-941-5717. What do our current nurses value at Michiana Behavioral Health & UHS? An environment that puts patient care first. One of the most rewarding aspects of working as a Registered Nurse (RN) is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. You are never alone, as you are part of a large network of peer nurses and nursing leaders that routinely exchange ideas and review current topics within the industry. Having the opportunity to grow, learn, and advance in your career. There are very robust continuing education options and opportunities for skills diversification and career advancement as a Registered Nurse (RN) with UHS. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Registered Nurse (RN) Job Requirements: Current license to practice nursing in the State of Indiana. Preferred one year of experience working in a psychiatric inpatient setting, however, willing to train the right individual that has a passion for children, adolescents, and adults with mental health and addiction disorders. Experience working with children and adolescents a plus. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Full-time

REGISTERED NURSE - DAY SHIFT

apartment UHS location_onPlymouth, IN

Responsibilities Registered Nurse – Day Shift – 6:00 a.m. – 6:30 p.m. Monday, Friday and every other weekend Michiana Behavioral Health is dedicated to creating a therapeutic environment that helps patients restore their health and get a fresh start. Located in Plymouth, Indiana, in a rejuvenating wooded setting, Michiana Behavioral Health provides each patient with comprehensive behavioral health treatment from compassionate and caring staff. Our leadership is committed to making sure every patient in our care receives high-quality care that gets them back on track at school, work, and home. Benefits for Registered Nurse (RN) include: Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Psychiatric Nurse Residency Transition-to-Practice Program (Could earn 20 CEUs) Career development opportunities within UHS and its 300+ Subsidiaries! 12-Hour Shifts; Set Schedules Tuition Assistance Loan Forgiveness $3000 Sign On Bonus If you would like to learn more about the Registered Nurse (RN) position before applying, please contact Becky Nowicki, Director Human Resources at becky.nowicki@uhsinc.com and by phone at 574-941-5717. What do our current nurses value at Michiana Behavioral Health & UHS? An environment that puts patient care first. One of the most rewarding aspects of working as a Registered Nurse (RN) is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. You are never alone, as you are part of a large network of peer nurses and nursing leaders that routinely exchange ideas and review current topics within the industry. Having the opportunity to grow, learn, and advance in your career. There are very robust continuing education options and opportunities for skills diversification and career advancement as a Registered Nurse (RN) with UHS. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Registered Nurse (RN) Job Requirements: Current license to practice nursing in the State of Indiana. Preferred one year of experience working in a psychiatric inpatient setting, however, willing to train the right individual that has a passion for children, adolescents, and adults with mental health and addiction disorders. Experience working with children and adolescents a plus. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Full-time

ADMISSION RN

apartment UHS location_onPlymouth, IN

Responsibilities Admission RN - Full-time Evenings Monday - Friday Michiana Behavioral Health (a UHS facility): Michiana Behavioral Health is seeking a full-time Admission RN to work evenings Monday - Friday from 2:00 p.m. - 10:30 p.m. Michiana Behavioral Health is dedicated to creating a therapeutic environment that helps patients restore their health and get a fresh start. Located in Plymouth, Indiana, in a rejuvenating wooded setting, Michiana Behavioral Health provides each patient with comprehensive behavioral health treatment from compassionate and caring staff. Our leadership team is committed to making sure every patient in our care receives high-quality care that gets them back on track at school, work, and home. For more information, please visit our website: https://michianabehavioralhealth.com We are currently seeking a full-time Admission RN. The Admission RN is responsible for: Incoming inquiry calls and walk ins Crisis Intervention Triage as needed Completes assessments and provides referrals if necessary Interface closely with Medical Staff, Treatment Team, and Managed Care Organizations Completes nursing assessments About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Requirements: Registered Nurse licensed in the State of Indiana Computer proficiency Good listening and communication skills Good organizational skills Good time management skills Have the ability to work independently Benefit highlights: Challenging and rewarding work environment Career development opportunities with UHS and its Subsidiaries Competitive Compensation Excellent Medical, Dental, Vision and Prescription Drug Plan 401(K) with company match and discounted stock plan Generous Paid Time Off Free Basic Life Insurance Tuition Reimbursement EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. A t UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Full-time

REGISTERED NURSE - NIGHT SHIFT 6:00 PM - 6:30 AM

apartment UHS location_onPlymouth, IN

Responsibilities Registered Nurse – Night Shift 6:00 p.m. - 6:30 a.m. Michiana Behavioral Health is dedicated to creating a therapeutic environment that helps patients restore their health and get a fresh start. Located in Plymouth, Indiana, in a rejuvenating wooded setting, Michiana Behavioral Health provides each patient with comprehensive behavioral health treatment from compassionate and caring staff. Our leadership is committed to making sure every patient in our care receives high-quality care that gets them back on track at school, work, and home. Benefits for Registered Nurse (RN) include: Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Psychiatric Nurse Residency Transition-to-Practice Program (Could earn 20 CEUs) Career development opportunities within UHS and its 300+ Subsidiaries! 12-Hour Shifts; Set Schedules Tuition Assistance Loan Forgiveness $3000 Sign On Bonus for Full-Time If you would like to learn more about the Registered Nurse (RN) position before applying, please contact Becky Nowicki, Director Human Resources at becky.nowicki@uhsinc.com and by phone at 574-941-5717. What do our current nurses value at Michiana Behavioral Health & UHS? An environment that puts patient care first. One of the most rewarding aspects of working as a Registered Nurse (RN) is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. You are never alone, as you are part of a large network of peer nurses and nursing leaders that routinely exchange ideas and review current topics within the industry. Having the opportunity to grow, learn, and advance in your career. There are very robust continuing education options and opportunities for skills diversification and career advancement as a Registered Nurse (RN) with UHS. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Registered Nurse (RN) Job Requirements: Current license to practice nursing in the State of Indiana. Preferred one year of experience working in a psychiatric inpatient setting, however, willing to train the right individual that has a passion for children, adolescents, and adults with mental health and addiction disorders. Experience working with children and adolescents a plus. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.