RN Appeals Nurse Job at Village Care, New York, NY

ZEtrdkhySGs1emFTVlNQYXl0dGkrOWFpTkE9PQ==
  • Village Care
  • New York, NY

Job Description

Job Description

Job Description

Appeals Nurse

VillageCareMAX

112 Charles Street, New York, NY 10014

VillageCare is looking for a self-motivated and passionate RN for our Appeals Nurse position. While supporting the Utilization Management team, the Appeals Nurse will conduct comprehensive analytic reviews of clinical documentation. This dynamic role will allow you to use your clinical knowledge to make authorization decisions, and assist with appeal determinations. Some of your responsibilities will include the following:

  • Collect information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation necessary to reach prospective, concurrent and retrospective decisions in the appeals process.
  • Review and interpret a variety of instructions and medical notes furnished in written and oral form to determine appropriate action towards appeal.
  • Write sound, factual, clinical arguments and attend Administrative Law Judge hearings for warranted appeals.
  • Detect problems, recognize important information, and link various data will be vital to this position.

We would like to speak to those who have a current unrestricted NYS RN license to practice professional nursing. Seeking those who bring a BSN (Master's degree preferred), along with 5+ years of practical experience in healthcare setting and 3+ years of quality management . Prior experience with analyzing data and knowledge of regulatory governance for CMS/DOH requirements required.

Must reside in the NY tri-state area: NY, NJ, or CT

There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you!

  • PTO package
  • 10 Paid Holidays
  • Personal and Sick time
  • Medical/Dental/Vision
  • HRA/FSA
  • Education Reimbursement
  • Retirement Savings 403(b)
  • Life & Disability
  • Commuter Benefits
  • Paid Family Leave
  • Additional Employee Discounts

VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.

VillageCare is an Equal Opportunity Employer.

Job Posted by ApplicantPro

Job Tags

Similar Jobs

Piedmont Healthcare

Respiratory Therapist, Nights Job at Piedmont Healthcare

 ...the National Board for Respiratory Care as a Registered Respiratory Therapist (RRT) and Licensed by the State of Georgia under the Composite State Board of Medical Examiners. ADDITIONAL QUALIFICATIONS: Current certifications in BCLS, ACLS, and PALS. Must be... 

BlueCross BlueShield of South Carolina

Summer Student Intern - Accounting Job at BlueCross BlueShield of South Carolina

 ...responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent...  ...and pose inquiries, are essential for ensuring a productive internship. We Prefer That You Have The Following: ~1 year of... 

PetSitter.com

Pet Sitter Wanted - Pet Sitter Wanted In Anderson, Ca Earn $20 Daily Caring For Furry Friends! Job at PetSitter.com

 ...who is reliable and can provide my two GSD mixes with the attention and care they need to break up the work week. Parker is a 13 year old German Shepherd Husky. Jaxon is a 7 year old German Shepherd Corgi. Duties include hanging out with them and taking them on a potty... 

Tacoma Public Schools

Head Coach Cross Country - Hilltop Heritage Job at Tacoma Public Schools

 ...promotes good sportsmanship in the conduct of team members and coaches. # Assumes responsibility for all phases of the program involving...  ...regarding program, facilities, and transportation problems; assists the building athletic director and district athletic director... 

Hungry Howie's Pizza & Subs

Delivery Driver Job at Hungry Howie's Pizza & Subs

 ...delicious Flavored Crust pizza. The pizza delivery role pays cash, daily! Get TIPS plus a competitive hourly rate & vehicle...  ...Hungry Howie's Pizza franchise. Benefits Flexible schedule Referral program Employee discount Paid training...