RN Appeals Nurse

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!

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.

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