RN Denial Prevention Lead - FT

Southern Hills Hospital in Las Vegas, NV

  • Industry: Healthcare - Nursing - Registered Nurse (RN/BSN/ASN)
  • Type: Full Time
  • Compensation: $84,980.00 - 108,480.00 / Year*


SHIFT: No Weekends

SCHEDULE: Full-time

Are you looking for a company that places integrity over their bottom line? Here at HCA, our everyday decisions are founded on compassion. Apply today and join a team that is dedicated to serving others in need.?


Southern Hills Hospital?is located in Southwest Las Vegas just off the I-215 and Durango/Sunset exit. The facility is an accredited 252-bed acute care hospital providing?emergency and pediatric emergency services, a behavioral health (geriatric psychiatric) inpatient and outpatient program serving ages 50 and older, accredited Chest Pain Center, a Certified Primary Stroke Center, a dedicated orthopedic and spine unit, OB-GYN, Level II NICU, diagnostic imaging and surgical services.??Southern Hills Hospital?was?voted the?Best Hospital in Las Vegas.


Utilizing advanced digital technology and an accomplished medical staff, Southern Hills Hospital's advanced care and superior service make for better outcomes and an exceptional patient experience.


The Joint Commission, the leading accreditor of healthcare organizations in America, recognized Southern Hills Hospital as a?Top Performer on Key Quality Measures??for 2010, 2011, 2012 and 2013 - the only Southern Nevada hospital to earn this recognition for four consecutive years.?


  • Southern Hills Hospital is the first institution in the state of Nevada to be recognized by the American Heart Association as a leading hospital in cardiology through their compliance with the ?Get with the Guidelines - Heart Failure? program.
  • In addition, Southern Hills Hospital earned The Joint Commission's Gold Seal of Approval? for its Alzheimer's disease program by demonstrating compliance with The Joint Commission's national standards for health care quality and safety in disease-specific care.
  • We have also partnered with award-winning spine physicians from the Nevada Neurosciences Institute.


Join us as we achieve our mission statement:


Above all else, we are committed to the care and improvement of human life.


Our employees come first.? We provide a total compensation package to make sure your needs are met.? Choose the medical coverage package that best suits you.? Look after your loved ones while still getting paid with our Paid Family Leave.? Plan for your future with our matching 401k or opt-in for several other benefits including tuition assistance, student loan repayment, family and medical flex spending accounts, life insurance, and identity theft protection.


HCA is dedicated to the growth and development of our colleagues.? We will provide you the tools and resources you need to succeed in our organization.? We are currently looking for an ambitious RN Denial Prevention Lead?to help us reach our goals.? Unlock your potential here!




Responsible for providing direction and oversight of concurrent denial prevention within Southern Hills Hospital. Maintains a current working knowledge of non-governmental and governmental payers and contracted language. The Lead maintains knowledge of payer trends and analysis of denials with a focus on prevention of denials within the acute setting. Will assist with the identification of strategies for prevention and initiate processes for denial avoidance. Monitors and provides detailed analysis of trends in the non-governmental sector. Provides direction and support to the assigned facility with root cause analysis of received denials.


Develops and implements action plans with interventions as needed with all facility departments. Identifies education opportunities within the facility and assists with communication required for intervention. Provides updates to developed reports/dashboards and communicates weekly with Division Denial Prevention Manager and facility CFO on all opportunities. Responsible for immediate intervention to assist facility prevent denial. Communicates appropriately with all relevant entities, Facility, Division, SSC and Payers.


If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our managers. Come unlock the possibilities and apply today!


We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.




  • Graduate of an accredited school of nursing required.
  • BSN strongly preferred


  • Minimum of 5 years of clinical healthcare experience in an acute care facility and other varied clinical settings
  • Minimum of 3 years of acute care case management experience preferred.
  • Understands basic principles of Utilization Review, Medicare/Medicaid, Managed Care, and regulatory compliance utilization management or?another health care provider financial setting.
  • Denial/appeal management experience required in commercial or managed care arena.
  • Clinical documentation improvement experience preferred.???


  • Current license to practice as a Registered Nurse in the state of Nevada required.


Our Company?s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking?here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-###-#### option 1.

Associated topics: coronary, hospice, intensive, intensive care unit, nurse clinical, psychiatric, registed, staff nurse, surgery, transitional

* Estimated salary

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