Health Advocates Network is currently seeking a Registered Nurse to work at a facility in Albany, New York. These are registry positions with our company. *$100 Sign-On Bonus*
Pay Rate: $67 / hour
*W2
Shift details:
8: 30am-4: 30pm/9am-5pm (Flexible)
Division functions:
Division of Medical and Dental Directors
The Division is responsible for the prior approval and pended claims functions for durable medical equipment, private duty nursing, hearing aids, vision care, and dental. The Division also manages the prior approval process for out-of-state nursing home placements, high tech radiology, the Center for Operational Excellence, and the Medical Indemnity Fund. The Bureau of Medical Review, within the Division of Medical and Dental Directors, performs Medicaid operational functions including prior authorization for supplies and services, review of pended claims for pricing, timeliness of submissions and adherence to Medicaid claims submission policy, prior authorization for Fee for Service (FFS) Medicaid beneficiaries seeking admission to skilled nursing facilities out of state, and operation of a call center to answer inquiries from providers and members about prior approval.
Position Description:
The Division of Medical and Dental Directors, Bureau of Medical Review:
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
Benefits:
-Medical
-Dental
-Vision
-Term Life
-Short-Term Disability Coverage
-401K
If interested, please apply through this job post. You may fax a copy of your most recent resume to 877-858-623. If you have any questions, please feel free to call at (800) 928-5561 and ask to speak with Vanessa (Monday-Friday 8: 30 AM-5: 00 PM PST). Refer friends, Earn rewards! Https://stafftoday.Staffingreferrals.Com/join/vdemont
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About Albany, NY
Ready to take the next step in your career? Explore our job opportunities in the vibrant Albany, New York area! Known for its rich history, stunning architecture, and thriving arts scene, Albany offers endless opportunities for professional growth. Whether you're strolling through Washington Park, catching a show at The Egg, or indulging in local delicacies like chicken riggies or spiedies, Albany's charm and unique culture will make your career journey even more rewarding. Join us in this dynamic region and discover why Albany is not just a job location but a place to thrive!
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