Job Title: Program Review Associate (RN) or (LPN)
Horizon Healthcare Staffing is searching for a Registered Nurse or LPN for one of our clients located in Western Nassau County.
- Monday through Friday
- 3-6 month assignment
- No Travel
- Nassau County, Long Island
This individual is responsible for review for external appeals for private sector clients; and assisting with other related nursing duties.
- 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.
- 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.
- Licensed as a Registered Professional Nurse in New York State.
- OR NYS Licensed Practical Nurse
- A minimum of one (1) year experience in an acute care facility preferably in medicine/surgery or special care units; and/or one (1) year experience in acute care utilization review.