Denials Management and Prevention RN

Job Summary: Primarily responsible for providing support to the Denials Management and Prevention Department in medical record review and/or denial review. 

About CarolinaEast Health System

CarolinaEast Health System is committed to providing high quality, compassionate care across the Coastal Carolina region. At the heart of our system is a 350-bed, full-service medical center equipped with a comprehensive range of inpatient and outpatient services, utilizing the latest medical technologies. We employ over 3,200 dedicated team members and operate physician practices across various specialties in four counties. Our employees foster a culture of excellence that ensures our patients receive the same high level of care found at larger medical centers, all while maintaining a friendly, community-centered atmosphere throughout our facilities. CarolinaEast offers a robust benefits package to all full-time employees, as well as benefits for part-time plus and part-time staff. We are proud to be the first medical center in North Carolina recognized as a Cardiovascular Center of Excellence by the American College of Cardiology and the American Heart Association. Additionally, we are honored to be named one of America’s Best-In-State Hospitals by Newsweek, among numerous other prestigious accolades.

Minimum Requirements: 

• Minimum of an Associate's degree in nursing. 


• Prefer a Bachelor of Science in Nursing. 


• Minimum five years hospital clinical experience. 


• Must possess strong clinical knowledge of patient care techniques, treatment modalities, and disease processes. 


• Knowledge of utilization review, denial concepts and reimbursement methodologies. 


• Ability to communicate effectively with interdisciplinary team (Physicians, Nursing, Denials Management and Prevention Manager, Care Coordinators, Billing and Finance). 


• Proficient in Microsoft Word, Excel, and selected denials tracking software.


• Current RN license with North Carolina State Board of Nursing or Compact License recognized by the NC State Board of Nursing. 


• Deliver outstanding customer service that upholds CarolinaEast's Standards of Excellence.