<p style="text-align:left">Screen reader users may encounter difficulty with this site. For assistance with applying, please contact <a href="mailto:hr-accessibleapplication@osu.edu" target="_blank" rel="noopener noreferrer"><span><span class="WEM0"><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">hr-accessibleapplication@osu.edu</span></span></span></a>. If you have questions while submitting an application, please review these <a href="https://hr.osu.edu/careers/faq/" target="_blank" rel="noopener noreferrer">frequently asked questions</a>.</p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left"><b>Current Employees and Students:</b></p><p style="text-align:left"><span>If you are currently employed or enrolled as a student at The Ohio State University, please l</span><span>og in to <a href="https://it.osu.edu/workday" target="_blank" rel="noopener noreferrer">Workday</a> to use the internal application process. </span></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left">Welcome to The Ohio State University's career site.  We invite you to apply to positions of interest. In order to ensure your application is complete, you must complete the following:</p><ul><li><p style="text-align:left">Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required.</p></li><li><p style="text-align:left">Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application. </p></li></ul><p style="text-align:inherit"></p><p style="text-align:inherit"></p><h2>Job Title:</h2>Clinical Financial Case Manager RN<p style="text-align:inherit"></p><p style="text-align:inherit"></p><h2>Department:</h2>Health System Shared Services | Revenue Cycle Clinical Support<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p><b><u>Scope of Position</u></b> </p><p></p><p>Revenue Cycle Clinical Support Office (RCCS) is an area within Access and Revenue Cycle Management Shared Services responsible for Clinical Pre-Certification, Case Reviews, Pre-billing edits, in-patient account validations, supporting Utilization Management, Peer to Peer processes, complex billing scenarios, audits (governmental, commercial, compliance, and internal), clinical appeals, internal and external escalations, and denial management. RCCS is integral to the Revenue Cycle and supports cash collection through preventing and appealing denials.</p><p></p><p><b><u>Position Summary</u></b></p><p></p><p>The Clinical Financial Case Manager, RN – Escalation Lead provides advanced clinical appeal services with a focused responsibility for review and escalation of complex patient account denials.  This role independently performs complex clinical reviews and evaluates relevant payer contractual terms and payer policies/guidelines to determine need for and method of escalation.  The Lead will monitor and report on commercial and governmental payer denial trends and assist in the development of denial prevention strategies, while maintaining a caseload of standard appeals as needed.</p><p></p><p>In a leadership capacity, the Lead assists the Manager as clinical and operational resource for the clinical appeals team, supporting complex case resolution, payer policy interpretation, regulatory compliance, and technology-enabled workflows. The Lead monitors payer and regulatory updates, disseminating this information with the team.  The Lead  assists the Manager in evaluating workflows for effectiveness, and in supporting the adoption of new tools and systems.  </p><p></p><p>The position assists the Manager in overseeing quality of clinical appeals and provides actionable quality assurance insights to management.  The Lead also assists the Manager in monitoring productivity and performance trends.  Through collaboration, coaching, and process improvement, the Lead aligns team operations with departmental goals, payer requirements, financial performance, and organizational technology initiatives.</p><p></p><p><b><u>Minimum Qualifications</u></b></p><p></p><p><b>For Hire: </b></p><ul><li>Bachelor’s Degree in Nursing (BSN) from an accredited nursing program.</li><li>Current, unrestricted Registered Nurse (RN) license in the applicable state of practice.</li><li>Minimum of 2 years of experience in claim denial escalation processes.</li><li>Minimum of five (5) years of experience in clinical appeals.</li><li>Minimum of five (5) years of relevant professional nursing experience, which may include utilization review, case management, prior authorization, precertification, care coordination, or related clinical revenue cycle functions.</li><li>Demonstrated working knowledge of medical necessity criteria, MCG/InterQual criteria, and governmental and commercial payer requirements.</li><li>Ability to independently review and interpret medical records, clinical documentation, and diagnostic testing to support quality assurance and payer compliance.</li><li>Proficiency in medical terminology and foundational knowledge of ICD-10 diagnosis coding and CPT/HCPCS procedural coding.</li><li>Experience using electronic health records (EHRs), payer portals, and clinical or revenue cycle technology platforms.</li><li>Effective written and verbal communication skills, including the ability to present QA findings and performance insights to leadership.</li></ul><p>  <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">         </span> Equivalency Statement:</p><p>An equivalent combination of education, licensure, and relevant experience may be considered in accordance with organizational HR policy.</p><p><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">           </span></p><p><b>Preferred:</b></p><ul><li>Advanced Degree.</li><li>Five (5) or more years of experience in claim denial escalation processes.</li><li>Prior experience in a lead, mentor, or informal supervisory capacity, including workflow coordination, staff education, onboarding, QA support, or performance coaching.</li><li>Advanced knowledge of payer policies, medical necessity guidelines, levels of care determination, and regulatory compliance requirements.</li><li>Experience supporting quality assurance activities, audits, denial management, data analysis, and process improvement initiatives.</li><li>Demonstrated ability to analyze operational and quality metrics, identify trends, and translate data into actionable recommendations for management.</li><li>Experience participating in or supporting implementation of new technologies, automation tools, analytics platforms, or system enhancements.</li><li>Strong facilitation and presentation skills, including experience educating clinical and non-clinical staff.</li><li>Professional certification related to case management, utilization review, or healthcare quality (e.g., CCM, ACM, CPUR) preferred.</li></ul><p style="text-align:inherit"></p><p style="text-align:inherit"></p><h2>Additional Information:</h2><p style="text-align:inherit"></p><p style="text-align:inherit"></p><h2>Location:</h2>Remote Location<p style="text-align:inherit"></p><p style="text-align:inherit"></p><h2>Position Type:</h2>Regular<p style="text-align:inherit"></p><p style="text-align:inherit"></p><h2>Scheduled Hours:</h2>40<p style="text-align:inherit"></p><p style="text-align:inherit"></p><h2><b>Shift:</b></h2>First Shift<p style="text-align:inherit"></p><p style="text-align:inherit"></p><div><div><div><div><div><div><div><div><p style="text-align:left"><i><b>Final candidates are subject to successful completion of a background check.  A drug screen or physical may be required during the post offer process.</b></i></p></div></div></div></div></div></div></div><div><div></div></div></div><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p>Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the <a href="https://osu.wd1.myworkdayjobs.com/en-US/OSUCareers/userHome" target="_blank" rel="noopener noreferrer">Candidate Home</a> section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the <a href="https://hr.osu.edu/careers/faq/" target="_blank" rel="noopener noreferrer">frequently asked questions</a>.</p><p></p><p>The university is an equal opportunity employer, including veterans and disability. </p>