RN Case Manager, Clinical Denial Management
Fort Lauderdale, Florida
Broward Health Corporate

Job Opportunity: Case Manager

Location: Fort Lauderdale, Florida
Employment Type: Travel/Contract
Contract Length: 13 weeks

Job Description

The Case Manager will focus on clinical denial management, including reviewing denied accounts, writing appeal letters, and resolving denials to recover outstanding accounts receivable. Responsibilities include:

• Conduct comprehensive reviews of denied accounts.
• Write compelling appeal arguments based on documentation and payer policies.
• Submit appeals and reconsiderations for claim rejections, underpayments, and denials.
• Research payer denials related to referral, eligibility, pre-authorization, non-covered expenses, and billing.
• Communicate payer trends and denial issues.
• Manage a work queue of accounts receivable and set follow-up activities based on claim status.
• Stay current with CMS guidelines, payer policies, contracts, and administrative bulletins.

Required Qualifications

• Valid Registered Nurse (RN) license in Florida
• Minimum 2 years of case management experience, including experience within the last year
• Acute hospital case management experience
• ACLS certification issued by American Heart Association or American Red Cross
• BLS certification issued by American Heart Association or American Red Cross
• NIH Stroke Scale (NIHSS) certification
• Associate of Science in Nursing (ASN) or Associate Degree in Nursing (ADN)
• Experience with clinical appeal letter writing
• Experience with Epic electronic medical record system

Additional Requirements

• Background check within 6 months including all locations lived/worked/schooled in the past 7 years
• Education verification and accreditation confirmation required
• Physical exam within 6 months of start, updated annually
• Negative QuantiFERON TB test within 6 months (no TSPOT or PPD accepted)
• Annual fit mask test with approved masks (3M 1860 Regular or Small)
• Negative 10-panel drug screen within 12 months
• Annual TB questionnaire
• Required immunizations or proof of immunity:

  • Measles (Rubeola), Mumps, Rubella (2 MMR vaccines or positive titer)
  • Hepatitis B series, titer, or signed declination
  • Varicella (2 vaccines, positive titer, or declination)
• Annual skills checklist
• State-mandated professional references (2 professional references within last 2 years)

Training and Compliance Modules

Candidates must complete various online orientation and training modules prior to start, including but not limited to:

• Clinical/Online Orientation
• Annual Risk Management
• General Compliance & Ethics Training
• Code of Conduct
• Emergency Management Education
• Preventing & Reporting Workplace Harassment
• Infection control and safety modules relevant to nursing
• Specialty nursing modules as applicable (e.g., Stroke Core Measures, IV Medication Safety, End of Life Care)

Notes

• Prior travel experience is not explicitly required for this position.
• Candidates must carry government-issued photo ID during hours of service.
• Badge photo and data security forms are required.
• Fingerprinting per Florida AHCA Level II standards is mandatory before start.
• Candidates must comply with all facility-specific documentation and training requirements.

This position is ideal for an experienced RN with strong case management and clinical denial expertise, comfortable working in a fast-paced revenue cycle environment.