Clinical Financial Case Management RN

• Address: OH
• Job Number: R150312
• Posted Date: 6/11/2026
• Type: Full time
• Remote or Hybrid: Remote

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Scope of Position

Revenue Cycle Clinical Support Office (RCCS) is an area within Access and Revenue Cycle Management Shared Services responsible for Clinical Pre-Certification, Case Reviews, Pre-billing edits, in-patient account validations, supporting Utilization Management, Peer to Peer processes, complex billing scenarios, audits (governmental, commercial, compliance, and internal), clinical appeals and denial management. RCCS is integral to the Revenue Cycle and supports cash collection through preventing and appealing denials.

Position Summary

Responsible for daily operational management of Revenue Cycle Clinical Support Staff, primarily involving the oversite of Clinical Pre-Certification, Peer to Peer, Clinical Appeals, Denial Analysis and Prevention for The Ohio State University Health System.

Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center. Functions within multidisciplinary teams leading staff to secure complex pre-authorizations and prevent/appeal clinical denials. The job duties require the utilization of clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided. Makes determinations on the appropriate level of care (Inpatient or Observation) based on the ability to read, understand, and interpret documented clinical information. Is a Subject Matter Experts (SME) for commercial and governmental payer requirements and audits such as RAC, MAC, QIO, etc. Maintains an awareness of State and National Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines. Manages escalation processes to administration regarding the need to cance...