This is a Full-Time position with a Monday-Friday schedule. Business hours are 7am to 3:30pm. No holidays or weekends required. Position is hybrid. Requires 1 day on-site at 4S Ranch and 4 days remote.

Must be local to San Diego.

Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide.

Why join Scripps Health?

AWARD-WINNING WORKPLACE:

• Fortune Best Workplaces in Health Care 2023
• 2023 PEOPLE Companies that Care
• Fortune 100 Best Companies to Work for 2023
• Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024
• Nearly a quarter of our employees have been with Scripps Health for over 10 years.

We invite you to join our Revenue Cycle team as a Registered Nurse of Appeals.

• In this role, you will be responsible for the following...
• Review and management of assigned cases for utilization review and system reimbursement.
• Responsible for completing government and commercial appeals for systemwide hospital billing.
• Understands basic denial rationales and identifies primary denial issue.
• Provides well written appeal arguments based on clinical evidence within the medical record and evidence-based literature.
• Participates in the coordination and completion of regulatory audits.
• Utilizes critical thinking, interpersonal and technical skills in data collection and denial management.

Preferred Education/Experience/Specialized Skills/Certification:

• BSN preferred.
• Certification in UR/UM or CM preferred.
• Previous UM, Discharge Planning, or Case Management experience is preferred.
• Understanding of financial reimbursements, state and federal insurance programs, and the revenue cycle is strongly recommended.
• Clinical documentation integrity experience preferred.

Required Education/Experience/Specialized Skills:

• Graduate of an accredited RN Program.
• Three to five years recent clinical experience in a variety of settings.
• Knowledge of InterQual and Milliman criteria.
• Ability to manage multiple tasks within regulatory agency time frames required.
• Strong computer skills including spreadsheet and data base management.
  
  

Required Certification/Registration:

• Current RN license issued by the state of California.