Registered Nurse/Medicaid Clinical Reviewer
G
Greenlife Healthcare StaffingHealthcare
New York, New York, United StatesFull-TimeJunior
Salary45 - 50 USD per hour
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Job Details
- Experience
- 1-3 years of experience in Case Review, Utilization, Billing, and coding review; 2 years of Med/Surg experience.
- Required Skills
- Analytical Skills
Requirements
- Graduate of an accredited nursing program
- Active RN State license and active NY State License
- 1-3 years of experience in Case Review, Utilization, Billing, and coding review
- InterQual and Milliman experience required
- Must have at least 2 years of Med/Surg experience
- Proficiency with Microsoft Outlook, Word, and spreadsheets
- Comfortable working extensively on computer systems
- Strong analytical skills
- Attention to detail
- Ability to work independently in a remote environment
Responsibilities
- Complete the full spectrum of activities related to Medicaid Utilization or Quality reviews as assigned.
- Conduct final level insurance appeals and review medical records.
- Conduct utilization reviews up to and including the appeal level, including 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.
- Use InterQual criteria to review the medical records of inpatient high cost hospital stays for admission and acute level of care.
- Review and validate itemized bills and write up responses to send to the hospital.
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