Clinical Nurse Specialist serves as a clinical expert providing teaching, mentoring, consulting, research, and systems improvement in a specific practice area or with a specific patient population. Coordinates and guides clinical activities/projects of nurses within a practice area. Being a Clinical Nurse Specialist collaborates with members of the health care team to design and implement safe, cost-effective, and evidence-based care strategies. May require a master's degree in nursing. Additionally, Clinical Nurse Specialist requires Registered Nurse (RN) License. Typically reports to a manager or head of a unit/department. The Clinical Nurse Specialist manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Clinical Nurse Specialist typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)
WHO WE ARE
With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.
WHAT YOU CAN EXPECT
Develop reports
Review governmental contractor’s response
Identify underlying root causes for potential denials and works closely with departments and Clinical Documentation Integrity to reduce denials
Write and ensure all appeals are filed in a prompt and timely manner for Medicare, Medicaid, Managed, and Commercials Payor
Audit medical documentation for adherence to insurance and CMS guidelines relating to inpatient/ observation services, or other denial issues
Knowledge of inpatient criteria to establish medical necessity letters
QUALIFICATIONS
Active Indiana RN license required
BSN or Associate's with 5 years of nursing experience required
3 years of denial experience required
5 years of nursing or case management experience preferred
TRAVEL IS REQUIRED:
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
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