Registered Nurse – Medicaid Clinical Reviewer
Greenlife Healthcare Staffing
full-time
Posted on:
Location Type: Remote
Location: New York • United States
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Salary
💰 $50 per hour
Job Level
About the role
- Conduct utilization reviews up to and including the appeal level. This includes chart screen, completing electronic worksheets, entering the required information, and making level one denial decisions when necessary.
- Conduct quality and clinical study data collection reviews.
- Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures.
- Participate in collaborative training specific to clinical study objectives.
- You will be using InterQual criteria to review the medical records of inpatient high cost hospital stays for admission and acute level of care.
- You'll also review and validate itemized bills and need to have the ability to write up responses to send to the hospital.
- Other activities as may be deemed necessary
Requirements
- Education: Graduate of an accredited nursing program
- Licensure: Active RN State license and active NY State License
- Experience: 1-3 years of experience in Case Review, Utilization, Billing, and coding review; InterQual and Milliman experience required
- Technical Skills: Proficiency with Microsoft Outlook, Word, and spreadsheets; comfortable working extensively on computer systems
- Soft Skills: Strong analytical skills, attention to detail, and ability to work independently in a remote environment
Benefits
- Competitive Compensation: Earn $45-$50 per hour based on experience
- Comprehensive Benefits:
- Paid Vacation based on accruals
- 6 Major Paid Holidays per year
- 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act
- License Reimbursement after 1 year of employment
- Health insurance is subject to plan eligibility requirements
- 401k Matching eligibility after 1 year of employment
- Benefits from Paychex, such as Payactiv
- GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization reviewcase reviewbilling reviewcoding reviewInterQualMillimandata collectionchart screeningdenial decision makingclinical study objectives
Soft Skills
analytical skillsattention to detailindependent workproblem-solvingtrainingcollaborationcommunication
Certifications
active RN State licenseactive NY State License