Utilization Management Registered Nurse

Job Title: Utilization Management / Appeals Registered Nurse

Job Details

• Posting Date: 10/21/2024
• Reference ID: 235039
• Locations: Openings in both Lake Success (New Hyde Park), NY or Albany, NY
• Work Location: Onsite
• Discipline: Nursing / Utilization Management
• Job Type: Contract-to-hire
• Salary Expectations: $50 - $54/hour
• Schedule/Shift: Monday to Friday, 8:00 AM - 5:00 PM

Job Description

Responsibilities/Job Duties:

• Conduct reviews for State and Federal Independent Dispute Resolution (IDR) case determinations, including prior authorizations and disputed benefit reviews.
• Review medical charts, compile regulatory guidance, research insurer requirements, and complete electronic worksheets.
• Prepare final determinations for disputed claims and appeals.
• Act as a resource for administrative and clinical staff by offering training, technical assistance, and conducting staff huddles.
• Mentor and train new RNs as the project expands.
• Assess and adjudicate claims, ensuring accuracy and compliance with regulations.
• Participate in collaborative training sessions and staff meetings.
• Handle a mix of simple and complex cases, reviewing documentation and coding for out-of-network bills to determine next steps.

Minimum Education and Experience Qualification Requirements:

Education:

• Baccalaureate degree in Nursing (BSN) required.
• Graduate of an approved Registered Professional Nursing program.

Experience:

• Minimum of 1 years in a clinical setting.
• Knowledge of Utilization Management, Appeals, or Clinical Documentation PREFERRED
• Familiarity with electronic medical records (EMR) systems.

Benefits:

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)
• Health Benefits / Dental / Vision (Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s).)
• 401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)
• Short Term Disability Insurance
• Term Life Insurance Plan