Registered Nurse Reviewer

New Wave People

Albany, NY

JOB DETAILS
SALARY
$50–$55 Per Hour
SKILLS
Adjudication, Case Management, Claims Processing, Code Reviews, Documentation, Equipment Maintenance/Repair, Healthcare, Medical Equipment, Medical Office, Medical Products, Medical Records, Medical Treatment, Microsoft Office, Nursing, Nursing Credentials, Nursing Home, Registered Nurse (RN), Safety/Work Safety, Surveillance, Team Player, Treatment Plan, Willing to Travel
LOCATION
Albany, NY
POSTED
18 days ago
Work Hours: 8:30am-4:30pm/9am-5pm (Flexible) (37.5 hrs per week)
hybrid position
Unpaid Lunch Break
Some Overtime No travel
No Work required on a NYS Holiday
Paid Parking Provided

Position Description:

The Nurse Reviewer will be assigned to the Medical Prior Approval Unit and will use the claims processing system and other electronic references to perform pre-payment, post-service adjudication of claims that pend for medical review. This function requires the use of professional medical judgment in the examination of claims and provider submitted documentation to substantiate the medical necessity for the requested services. The position involves utilizing national standards for procedure and diagnosis coding, reviewing appropriate combinations of medical services, and identifying methods to prevent fraud and abuse.

Additional Skill Level, Experience or Other Requirements:
  • Current licensed as registered professional nurse in NYS
  • Three years post licensure professional nursing experience, at least two years which must have been in a licensed healthcare facility. (School nursing or medical office experience does not apply.)
  • Experience in prior approval of medical supplies/equipment/services or experience in examination of medical records, documentation, and proposed treatment plans for medical necessity
  • Experience with national standards for procedure and diagnosis coding is preferred
  • Previous claims experience preferred but not required
  • Nursing home surveillance/case management experience is preferred but not required
  • Experience with Microsoft Office
  • Proficient in the use of standard office technology
  • Ability to be flexible, innovative, and work in a team environment
Salary Commensurate with scope of work job experience
Business Casual and footwear to perform tasks in a safe manner.
This job description is not intended to be all inclusive and employee will be expected to perform other reasonably related duties as assigned.
New Wave People is an Equal Opportunity Employer (EEO).

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About the Company

N

New Wave People

New Wave People, Inc. (NWP) is an established Woman Owned Small Business (WOSB), Minority, and Economically Disadvantaged (EDWOSB) business.  We are recognized by diverse organizations for our many contributions to the business world and the communities we serve. We have been honored among the Top 100 Hispanic-owned businesses in the United States by DiversityBusiness.com.   New Wave People provides professional contingent staffing for both short-term, or long- term assignments.  Our clients may request one contractor from us, or an entire project team with management oversite. We offer a wide variety of personnel to government and corporate clients nationwide. NWP’s management team with over 130 years of staffing industry experience is very proud to deliver quantifiable results to our clients and our employees exemplifying our commitment to business excellence and community.

 

 

COMPANY SIZE
100 to 499 employees
INDUSTRY
Staffing/Employment Agencies
FOUNDED
2000
WEBSITE
http://www.nwpusa.com/