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Breakthrough Resource Management

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tms

Senior Resource Manager

Chicago, IL · On-site

... management and delivery. Operating as a creative agency, a strategic consultancy, a sourcing ... WHAT MATTERS THE MOST Breakthrough, business-driving ideas come from extraordinary people with the ...

tms

Senior Resource Manager

Chicago, IL · On-site

... management and delivery. Operating as a creative agency, a strategic consultancy, a sourcing ... WHAT MATTERS THE MOST Breakthrough, business-driving ideas come from extraordinary people with the ...

Breakthrough T1D

Development Manager

Chicago, IL · Hybrid

We provide resources and guidance that makes it easier to live and thrive with T1D. This is more ... The Development Manager (DM) at Breakthrough T1D is integral in the day-to-day execution of ...

Breakthrough

Salesforce Administrator

Chicago, IL · Hybrid

Each year, Breakthrough has the opportunity to work with over 6,000 local residents and their ... Manage user accounts, roles, security, profiles, and licenses. * Create and maintain record types ...

Breakthrough T1D

Development Manager

Miami, FL · On-site

We provide resources and guidance that makes it easier to live and thrive with T1D. This is more ... The Development Manager (DM) at Breakthrough T1D is integral in the day-to-day execution of ...

Breakthrough T1D

Development Manager

Miami, FL · Remote

We provide resources and guidance that makes it easier to live and thrive with T1D. This is more ... The Development Manager (DM) at Breakthrough T1D is integral in the day-to-day execution of ...

Breakthrough T1D

Development Manager

Atlanta, GA · On-site

We provide resources and guidance that makes it easier to live and thrive with T1D. This is more ... The Development Manager (DM) at Breakthrough T1D is integral in the day-to-day execution of ...

Breakthrough T1D

Development Manager

Chicago, IL · On-site

We provide resources and guidance that makes it easier to live and thrive with T1D. This is more ... The Development Manager (DM) at Breakthrough T1D is integral in the day-to-day execution of ...

Breakthrough T1D

Development Manager

Boca Raton, FL · Remote

We provide resources and guidance that makes it easier to live and thrive with T1D. This is more ... The Development Manager (DM) at Breakthrough T1D is integral in the day-to-day execution of ...

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Infographic showing various job openings at Breakthrough Resource Management in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 33% Physical, and 67% Remote job distribution.

Denial and Appeals RN / Clinical Resource Management

Hartford HealthCare at Home

Wethersfield, CT • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Work where every moment matters.
Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.
The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.
Department Description:
Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment.
Position Summary:
The Denial and Appeals Nurse is an integral part of the Care Management team. Their focus is on the management of the payer denial and appeals process. The Denial and Appeals Nurse is responsible for appealing inappropriate denials through all levels of the appeals process. The Denial and Appeals Nurse is able to work autonomously and swiftly, managing a high volume of complex cases across all HHC system hospitals.
Key Areas of Responsibilities:

  1. Follow standard work processes to manage denials and appeals
  2. Ensure activities are completed within regulatory and payer timeframes
  3. Develop and maintain collaborative relationships with internal and external stakeholders as needed to obtain additional information to properly formulate the clinical appeal and to resolve any issues that may arise during the appeals process
  4. Partner with the Medical Director and Physician Advisor staff to compose factually sound appeal letters for denial reconsiderations utilizing clinical documentation and contract language
  5. Maintain all documentation associated with the processing and handling of appeals to comply with regulatory standards and timeframes while maintaining an accurate, complete appeals record in the appropriate database
  6. Assist in analysis and documentation of root cause for denials
  7. Provide education to stakeholder groups on findings, analysis and mitigation strategies as needed
  8. Work with multi-disciplinary team to identify denial / appeal trends and supports development of performance improvement strategies in response to identified patterns
  9. Other duties as assigned.

Reports To: Manager, Clinical Resource Management
Qualifications:
Education: Registered Nurse. Bachelors of Science in Nursing is preferred.
Experience: Five years of relevant case management, utilization management or managed care experience.Thorough understanding of Medicare, Medicaid, and Commercial reimbursement methodologies is preferred.
Licensure, Certification, Registration: Current State of Connecticut RN license is required. CCM (certified case manager), CPUM (certified professional in utilization management), or other relevant certification is preferred.
Knowledge, Skills and Ability Requirements:
  • Strong interpersonal and written / oral communication skills
  • Maintains a positive attitude in a fast-paced environment
  • Able to influence and negotiate
  • Critical thinking, astute assessment and confident in decision making
  • Knowledge of Interqual, MCG, or equivalent criteria and reimbursement guidelines
  • CT RN license required without restriction, to the extent allowed by State and Federal law.
  • Use of Microsoft Office including Word, Excel, and Power Point
  • Use of EPIC

We take great care of careers.
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.
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About Hartford HealthCare at Home

Sourced by ZipRecruiter

Hartford HealthCare at Home, based in Wethersfield, Connecticut, US, is a premier provider in the healthcare industry, specifically in home-based care services. Their official website can be accessed at hartfordhealthcareathome.org. They offer a wide range of services including nursing, physical therapy, occupational therapy, speech therapy, social work, and home health aid. The company was established with the mission to enhance the capability of people to achieve optimal health and wellbeing through its home care services. They maintain a patient-centric approach and belief in making a real difference in people's lives. As an integral part of Hartford HealthCare, they share the vision to be “most trusted for personalized coordinated care”.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Wethersfield, CT, US

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