Non Clinical Registered Nurse - 240421 Job at Medix™, New Hyde Park, NY

WGFoZ3BlSkxZVTRSeUJaRTUrdFJmNktkS0E9PQ==
  • Medix™
  • New Hyde Park, NY

Job Description

Job Title: Non-Clinical RN

Experience: Open to various clinical backgrounds/experience. Must have 2+ years of clinical experience post graduation, must has critical thinking and problem solving skills.

***Must have BSN and NYS RN license***

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

Hours of Operation: M-F 7a-5:30p *flexible start between 7am-9am (40hrs/wk)

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.

QUALIFICATIONS:

  1. Knowledge and experience with electronic medical records.
  2. Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
  3. Excellent written and verbal skills.
  4. Ability to work independently with little supervision.
  5. Ability and desire to be flexible, innovative, and creative.

EDUCATION AND EXPERIENCE:

  1. Licensed, Registered Nurse, required in New York
  2. Baccalaureate degree in Nursing
  3. Minimum of two years’ experience in a clinical setting, required.

Job Tags

Immediate start, Flexible hours,

Similar Jobs

Air Sea Packing Group

Art Handler Job at Air Sea Packing Group

 ...Experienced Art Handler If youre looking to grow in the world of fine art logistics and you have a passion for it, then we just may have the perfect role for you! We are seeking talented and driven Experienced Art Handler to join our organization. The ideal candidate... 

The Jewish Leadership Academy

English Teacher Job at The Jewish Leadership Academy

 ...nurture a sense of empathy, and cultivate an appreciation for self-expression and the written word. Middle school classes will be year-...  ...semester classes: a multi-genre writing workshop and an American literature course. From there, they may choose pairs of electives... 

J & J Staffing Resources

Temporary Administrative/Professional Positions Job at J & J Staffing Resources

 ...Our client in Little Egg Harbor, NJ, is seeking an Administrative Assistant to help out their office. This is an Ongoing Temporary role with the potential to become Temp-to-Hire for the right candidate. The schedule for this role can be either Monday through Friday, 7:... 

Wripple

Senior Freelance Copywriter Job at Wripple

Wripple is looking for a seasoned Senior Copywriter for one of our clients in the airline industry. This is a 40 hour/week, hybrid onsite long-term contract role - initial contract running through EOY, with opportunities to extend. You must be able to go onsite to the...

Forge Search

President / Chief Staff Executive Job at Forge Search

We are partnering with a mission-driven nonprofit organization to identify their next Executive Director. This role offers the opportunity to lead a well-established, statewide organization focused on improving health outcomes for children through strong community partnerships...