Nursing Jobs in Bryn Athyn, PA
$92,289.60 - $120,577.60 / year
Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $92,289.60 - $120,577.60 Scheduled Weekly Hours: 40 Position Overview Responsible for clinical review, development, and submission of inpatient and outpatient clinical appeals for denied hospital claims. This role applies clinical expertise, medical record analysis, MCG clinical criteria, and payer-specific clinical policies to support medical necessity, patient status, and other clinical determinations in order to maximize appropriate reimbursement and reduce avoidable denials. MINIMUM REQUIREMENTS Education: Graduate of an accredited school of nursing required. Experience: Three years' clinical nursing experience required. Experience in utilization review, case management, clinical appeals, CDI, or denial management required. Other Credentials: AHA BLS - Healthcare Provider,Registered Nurse - NJ CPR Requirements: Requires ACLS (or must obtain within 6 months of hire date) if assigned to: Critical Care/Intermediate/Telemetry, Emergency Rooms, Pediatrics/Pediatrics Emergency Room, Labor & Delivery, Surgical Services (not to include Perioperative), Interventional Procedures, Observation. Requires NRP (or must obtain within 6 months of hire date) if assigned to: Maternity Services Requires PALS (or must obtain within 6 months of hire date) if assigned to: Emergency Rooms, Infant Follow-Up, Surgical Services (only PACU & Same Day Surgery), Pediatrics/Pediatric ED. Knowledge and Skills: Required familiarity with MCG clinical criteria for inpatient and outpatient medical necessity and patient status determinations. Required familiarity with payer-specific clinical policies, medical necessity guidelines, and appeal requirements. Strong understanding of inpatient and outpatient medical necessity and patient status criteria. Ability to analyze medical records and synthesize clinical evidence into clear, persuasive written arguments. Strong written and verbal communication skills. Ability to work collaboratively with physicians, physician advisors, CDI, UR, and non-clinical denial staff. Proficiency with hospital information systems and Microsoft Office applications. Strong written and verbal communication skills. Ability to work collaboratively with physicians, physician advisors, CDI, UR, and non-clinical denial staff Special Training: Mental, Behavioral and Emotional Abilities: Proficiency with hospital information systems and Microsoft Office applications Usual Work Day: 12 Hours Reporting Relationships Does this position formally supervise employees? No If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager. ESSENTIAL FUNCTIONS Conducts comprehensive clinical review of denied inpatient and outpatient claims using MCG criteria and payer clinical policies to determine appeal viability. Prepares written clinical appeals and rebuttals supported by medical record documentation, MCG criteria, and payer-specific policy language Collaborates with Utilization Review, Case Management, CDI, physicians, and physician advisors to support appeal development Prepares appeal packets, ensuring completeness, accuracy, and compliance with payer submission requirements and deadlines Maintains clear and concise documentation in hospital systems related to appeal actions and clinical rationale. Identifies recurring clinical denial trends related to MCG criteria application or payer policy interpretation and escalates findings to leadership. Maintains current knowledge of MCG updates, payer policy changes, and industry best practices Participates in audits, education initiatives, and process improvement activities related to clinical denials and appeals Performs other duties as assigned and adapts to changing departmental demands. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion , Taste or Smell Occasional physical demands include: Sitting , Climbing (e.g., stairs or ladders) Continuous physical demands include: Standing , Walking , Carry objects , Talk or Hear Lifting Floor to Waist 35 lbs. Lifting Waist Level and Above 25 lbs. Sensory Requirements include: Very Accurate 20/40, Near Vision, Very Accurate 20/40, Far Vision, Color Discrimination, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease , Dust/Particulate Matter This position is eligible for the following benefits: Medical Plan Prescription drug coverage & In-House Employee Pharmacy Dental Plan Vision Plan Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA Retirement Savings and Investment Plan Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Supplemental Group Term Life & Accidental Death & Dismemberment Insurance Disability Benefits – Long Term Disability (LTD) Disability Benefits – Short Term Disability (STD) Employee Assistance Program Commuter Transit Commuter Parking Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child Voluntary Legal Services Voluntary Accident, Critical Illness and Hospital Indemnity Insurance Voluntary Identity Theft Insurance Voluntary Pet Insurance Paid Time-Off Program The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria. 
$155,000 - $170,000 / year
Join our team at Marquis Health Consulting Services as a Regional Director of Nursing Services in the Philadelphia, PA area. Full-time opportunity available $155k-$170k per year depending on experience At Marquis Health Consulting Services, we are committed to delivering exceptional clinical care through strong leadership, regulatory excellence, and continuous quality improvement. Guided by our core values of Passion, Respect, and Excellence , the Regional Director of Nursing Services provides clinical oversight and operational support to multiple skilled nursing facilities, partnering with leadership teams to enhance resident outcomes, ensure regulatory compliance, and promote evidence-based nursing practices. Responsibilities for Regional Director of Nursing Services: Provide clinical leadership and support to multiple skilled nursing facilities to promote quality resident care and regulatory compliance. Assist facility leadership in managing urgent clinical situations, high-risk events, and regulatory concerns. Conduct survey readiness activities, mock surveys, and provide support during state and federal survey processes. Develop, coordinate, and deliver clinical education and training programs for nursing leadership and staff. Support the implementation of new clinical programs, evidence-based practices, and company initiatives. Provide guidance on resource allocation, acuity-based staffing, and consistent assignment practices. Collaborate with facility leadership to strengthen Quality Assurance and Performance Improvement (QAPI) initiatives and monitor clinical outcomes. Review and update clinical systems and practices to ensure compliance with changing regulations and standards of care. Communicate promptly about identified care concerns, adverse events, and compliance matters, and partner with facility leadership to implement corrective actions. Collaborate closely with Regional Directors of Operations, facility Administrators, Directors of Nursing, and corporate clinical leadership to support operational and clinical excellence. Travel regularly to assigned facilities to provide on-site leadership, education, and operational support. Perform other duties as assigned. Qualifications for Regional Director of Nursing Services: Current, active, and unencumbered Registered Nurse (RN) license in the state of PA required. Minimum of three (3) years of clinical leadership experience in a Long-Term Care, Rehabilitation, or Skilled Nursing setting. Multi-facility clinical management or consulting experience preferred. Ability to travel extensively and provide on-site support across multiple facilities. Valid driver's license with a satisfactory driving record required. Strong knowledge of long-term care regulations, survey processes, quality assurance, infection prevention, and evidence-based nursing practices. Working knowledge of the Resident Assessment Instrument (RAI)/MDS process. Strong analytical, critical thinking, and decision-making skills. Excellent written, verbal, and interpersonal communication skills. Proficiency with Microsoft Office and electronic clinical documentation systems. Ability to work independently while building collaborative relationships with facility leadership, residents, families, and interdisciplinary teams. Ability to maintain confidentiality and exercise sound judgment when handling sensitive clinical and organizational information. Our Core Values in Action Passion – Inspiring clinical excellence through education, mentorship, and unwavering dedication to resident-centered care. Respect – Building trusted partnerships with residents, families, and healthcare teams through collaboration, integrity, and professionalism. Excellence – Driving continuous quality improvement, regulatory compliance, and evidence-based clinical practices to achieve outstanding resident outcomes. Benefits as Regional Director of Nursing Services: Health, vision, and dental benefits 401(k) with match Employee engagement and culture committee Company-sponsored life insurance Employee assistance program (EAP) resources The facility provides equal employment opportunities to all applicants and employees and prohibits discrimination and harassment of any kind. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by federal, state, or local law. All qualified applicants are encouraged to apply. 
