Nurse Reviewer – RN / LPN

Horizon Healthcare Staffing
    Published
    November 24, 2021
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    Category
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    Description

    Nurse Reviewer

    Horizon Healthcare Staffing is searching for Registered Nurses or LPNs to conduct reviews. This is a temp to perm assignment located in New Hyde Park, NY.

    Job Details:

    • Monday - Friday
    • 8:30am-5pm
    • Start Immediately!

    This individual is responsible for review for external appeals review for private sector clients; and assisting with other related nursing duties.

     

     

    Responsibilities

    Responsibilities:

    • Responsible for the daily review for external appeals contracts.
    • Assists physician reviewers to complete review activities and bring problems to the attention of the Assistant Director.
    • Conducts on-site reviews and facility inspections for specific contracts, as needed.
    • Responsible for clinically related reviews for all private sector clients.
    • Assist with development of new review tools as products are developed.
    • Assist with special projects for the private sector, and other activities as necessary.
    • Screening and write-up of external appeal review cases.
    • Follow-up with patients, insurers and providers relative to the external appeal process.
    • Preparation of final report determinations for external appeals.
    • Tracking of cases to ensure timely response.
    • Participation in rotational schedule to ensure coverage for emergency appeals.

    Qualifications

    Qualifications:

    • RN License in NY or LPN License in NY
    • Strong interpersonal skills with the ability to effectively interact with physicians, senior medical and administrative personnel.
    • Strong communication skills (written and verbal).
    • Ability to work independently with minimal supervision.
    • Ability to meet short turnaround deadlines for deliverables.
    • Ability to provide rotating pager coverage for external appeals 24 hours/7 days per week.
    • Working knowledge of Microsoft Word and Excel.
    • Ability to travel to hospital/facility review assignments, as needed.
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