Registered Nurse/Medicaid Clinical Reviewer

Greenlife Healthcare Staffing•New York, NY

2d•$45 - $50•Remote

About The Position

We are seeking an experienced Registered Nurse to join our team as a Medicaid Clinical Reviewer. This fully remote position involves conducting clinical reviews for Medicaid cases, ensuring compliance with state regulations, and contributing to quality improvement initiatives for a respected non-profit organization.

Requirements

Graduate of an accredited nursing program
Active RN State license and active NY State License
1-3 years of experience in Case Review, Utilization, Billing, and coding review; InterQual and Milliman experience required
Proficiency with Microsoft Outlook, Word, and spreadsheets; comfortable working extensively on computer systems
Strong analytical skills, attention to detail, and ability to work independently in a remote environment

Responsibilities

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.
Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures.
Participate in collaborative training specific to clinical study objectives.
You will be using InterQual criteria to review the medical records of inpatient high cost hospital stays for admission and acute level of care.
You'll also review and validate itemized bills and need to have the ability to write up responses to send to the hospital.
Other activities as may be deemed necessary