Lead Nurse Consultant

This is a fully remote position, open to applicants in Alabama, +27 more states.

📋 Description

• Manage departmental operations concerning clinical denials, emphasizing team effectiveness and quality.

• Organize Clinical Case Study presentations for Revecore clients, handling invitations, communications, and preparations at the Nurse Consultant level.

• Onboard, train, and guide new nursing staff.

• Engage in departmental quality assurance and ensure compliance with relevant guidelines and deadlines.

• Assist Nurse Supervisors and the Manager in managing nurse workflow.

• Provide support to nurses regarding account-related inquiries related to appeals and denial resolutions.

• Update Nurse Supervisors and the Manager on client communications, issues, needs, staffing, and personnel matters.

• Aid in the preparation of client, payor, and company reports.

• Support the management and updates of departmental work plans.

• Draft and submit appeal letters, emails, online inquiries, and reports.

• Establish relationships with clients and Revecore staff.

• Participate in client, departmental, and company meetings.

• Adhere to federal and state regulations, as well as company policies and procedures.

• Perform additional duties as assigned.

⛳️ Requirements

• A college degree or diploma from a nursing school – a licensed RN is required.

• At least 5 years of experience in denials and appeals and/or hospital revenue cycle.

• Familiarity with MCG, InterQual, NCD/LCDs, payor medical policies, and reimbursement practices.

• Clinical nursing experience in a hospital setting, preferably in ER, ICU, Med-Surg, or Transplant units.

• Moderate computer skills, including proficiency in Microsoft Word, PowerPoint, Excel, and PDF files.

• Exceptional interpersonal and communication abilities.

• Strong mathematical skills: capability to calculate rates using addition, subtraction, multiplication, and division.

• Ability to read and comprehend a wide range of documents such as contracts, claims, instructions, policies, and procedures in both written and diagram formats (in English).

• Proficiency in writing routine correspondence in English.

• Strong customer service mindset.

• Excellent team player.

• Dedication to company values.

• A secure internet connection is mandatory.

• Home internet must have speeds greater than 20 Mbps for downloads and greater than 10 Mbps for uploads.

• Workspace should accommodate workstation equipment and related materials, providing sufficient surface area.

• Must reside in the United States within one of the designated eligible states.

• Employment eligibility in the United States, verification of employment history, and successful completion of a background check are required.

🏝️ Benefits

• Remote work arrangement

• Work-from-home setup with a quiet, distraction-free environment

• Flexible work-from-home arrangement

• Equal employment opportunity workplace