Career Opportunities

Clinical Appeals Nurse - Patient Financial Services - FT Days at Careers | UC Irvine Health - 13296

Updated: November 7, 2019
Job Family: Professional

Job Description & Salary Range


UC Title:                                    Reimbursement HC Analyst 4

Position Number:                    10007016

Reports to:                               Dir, Patient Financial Svcs

Working Title:                          Reimbursement HC Analyst 4

Cost Center:                             Patient Financial Services (8550)

Bargaining Unit:                      None

FLSA:                                        Exempt

Job Code:                                 6768

Date Created:                           11/04/2019

Shift:                                         Day Shift

Hours:                                       40.00


Position Summary: 

Incumbent is responsible for planning, directing and overseeing all aspects of Clinical Appeals and Charge Audits. The Clinical Appeal Nurse will be in charge of initiating the appeal process and developing victorious appeal letters to support medical necessity or level of care. Provides necessary training and education to staff involved in processes and ensures standards complies with federal, state and other regulatory agency rules and regulations. Works with Care Management leadership and Physician Advisors to ensure knowledge of denial to improve impactful areas. Actively participates on organizational performance improvement projects. Serves as a role model and resource to colleagues, staff and others.


Salary Range: 


Rate    Minimum  $68,500.00    Maximum  $140,200.00


Required Qualifications:

3 year experience with InterQual/MCG Guidelines required

3 years' working in an Acute Hospital Utilization Management, Concurrent Review Process or Care Management area

Ability to establish and maintain effective working relationships across the HealthSystem

Ability to maintain a work pace appropriate to the workload

Bachelor of Science in Nursing

Demonstrated ability to lead change and effectively manage conflict

Excellent analytical skills

Excellent working knowledge of desktop computer productivity tools

Excellent written and verbal communication skills in English

Experience generating victorious Appeal Letters

Knowledge of CMS, DHCS, Joint Commission, CADP, and other regulatory and compliance requirements

Must demonstrate customer service skills appropriate to the job

Must possess the skill, knowledge and abilities essential to the successful performance of assigned duties

Outstanding interpersonal skills; ability to interact effectively at all levels of the organization

Proficiency in Microsoft Office suite

Strong knowledge and understanding of ICD-10 and CPT codes


Preferred Qualifications:

Knowledge of University and Medical Center organizations, policies, procedures and forms

Knowledge of patient safety strategies

Knowledge of quality improvement methodologies


Physical, Mental & Environmental Demands:

To comply with the Rehabilitation Act of 1973 the essential physical, mental and environmental requirements for this job are listed below. These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all of the functions of the job with or without reasonable accommodation.



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