Job Description:
• 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. This includes a chart review, complete detailed electronic data worksheets.
• Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles.
• Participate in collaborative training specific to clinical study objectives.
• Other activities as may be deemed necessary.
Requirements:
• Education: Graduate of an accredited nursing program
• Licensure: Active New York State RN license
• Experience: Must have 1-3 years of experience in acute care utilization review/appeals background.
• Technical Skills: Must be comfortable working on a computer. Familiar with Outlook, spreadsheets, and Word.
• Soft Skills: Strong analytical abilities, attention to detail, and ability to work independently in a remote environment
Benefits:
• Competitive Compensation: Earn $50 per hour
• Comprehensive Benefits:- 1 Week of Paid Vacation based on accruals after 3 months of employment (2 weeks of Paid Vacation with accrual starting your second year of employment)- 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.