LTSS Review Nurse (Fully Remote)

We are hiring a Remote Utilization Review Nurse (for LTSS services) (RN). This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services for long term support services!

The LTSS Nurse role is specifically for the LTSS (Long Term Support Services) line of business. This means for the candidate requires experience conducting LTSS Reviews (Home health aides, adult day care services, personal care, etc)

Key/Essential Functions & Responsibilities:

• Reviews planned, in process, or completed long term support ervices to ensure medical necessity and effectiveness according to evidence-based criteria - CMS guidleines.
• Frequently collaborates and communicates with physician peer reviewers and medical directors in determining coverage of requested services.
• Provide intervention and coordination to decrease delays and denials.
• Maintains timely, complete and accurate documentation in compliance with policies and procedures.
• Support Quality and Performance Improvement Initiatives.
• Timely follow-up on results of denial and internal appeal

Specifics:

Requirements: Active RN in NY (LTSS / MLTC experience conducting reviews using CMS guidleines)

Hours Monday - Friday 9am-5pm (Full time only)

Location: Fully Remote

Remote: Fully Virtual (Work from Home)

Pay: $90,000 - $98,000

Job Type: Direct Hire (full benefits, PTO and retirment plans).

Qualifications

• Must be a self-assured professional with a current New York State Registered Nurse License required.
• CMS experience REQUIRED

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