Clinical Financial Case Manager

hace 2 semanas


Mayagüez, Mayagüez, Puerto Rico Ohio State University Wexner Medical Center A tiempo completo

Position Summary: The Ohio State University Wexner Medical Center is seeking a skilled Clinical Financial Case Manager to establish financial controls and policies, ensuring their effective implementation and execution. This individual will be responsible for preparing and interpreting financial and operational reports, as well as supporting strategic decisions.

Key Responsibilities:

  • Coordinate insurance verification and prior authorization of outpatient medications using clinical knowledge.
  • Provide evidence to support cutting-edge therapies and educate payers on current standard of care treatment.
  • Identify trends and areas for needed clinical education to decrease denials.
  • Submit test claims to mitigate the risk of denial.
  • Understand and verify benefits, and obtain prior authorization for outpatient medications.
  • Communicate with patients and families to obtain demographic, financial, and insurance information.
  • Utilize the electronic medical record system to obtain pertinent medical information.
  • Evaluate and solve complex customer problems, and consult with the clinical team.

Requirements:

  • Bachelor's Degree in Nursing, Pharmaceutical Sciences, or a similar clinical healthcare field.
  • At least 1 year of clinical experience, preferably in oncology and/or pharmacy.
  • Experience in physician practice and/or utilization review is a plus.
  • Knowledge of Medicare and commercial insurance reimbursement is desired.
  • Strong knowledge of medical and pharmaceutical terminology is highly desired.
  • Proficient in computer-based research and medical record documentation.
  • Experience in interpreting insurance benefit information and completing prior authorization processes is preferred.


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