The Denials Manager appeals all denials using InterQual criteria.  Evaluates, tracks and trends denials and implements denial prevention programs.  Works closely with Case Managers, Physicians and multidisciplinary team to ensure compliance with documentation and educates as needed.

The position requires the full understanding and active participation in fulfilling the mission of AHMC- Anaheim Regional Medical Center.  It is expected that the employee demonstrate behavior consistent with the core values.  The employee shall support AHMC- Anaheim Regional Medical Center strategic plan and goals and direction of the performance improvement plan.

Licenses/Certifications

RN License in the State of California required

BSN preferred

BLS

Certified Case Manager preferred