Are you looking to take your nursing career to the next level? We're seeking Registered Nurses for an Appeals RN opportunity working in New Hyde Park, NY.

Job Title: Appeals RN (BSN and NYS RN licensed need)

***appeals experience NOT required***

Experience: Must have 2+ years of clincal experinece post grad, strong computer skills, problem solving skills and critical thinker. Open to various backgrounds/experience

Location: Onsite required; office in New Hyde Park, NY

Hours of Operation: M-F 7a-5:30p (can start between 7am-9am, 8 hour days)

Start date: ASAP

Pay: $50-54/hr *DOE

Volume: Will do appeals work under the IDR team handling on average 10 cases a day. These will be a mix between simple and complex cases. They will be reviewing documentation, codes, and more for out of Network bills and cost and making determinations on how to move forward based on the evidence.

This individual will complete the full spectrum of activities related to State and Federal Independent Dispute Resolution (IDR) case determinations. They will conduct clinical level review, Prior Authorization, and disputed benefits review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.

DUTIES:

1. Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, complete electronic worksheets and preparing final determinations.
2. Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles.
3. Training and mentoring new RNs as the project expands.
4. Claims assessment and adjudication.
5. Participate in collaborative training.
6. Other activities as may be deemed necessary.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.