Program Review Associate (RN)
The Program Review Associate (RN) will complete the full spectrum of activities related to Cost Outlier or Utilization reviews as assigned. They will utilize their knowledge and expertise of the review program to support Medical Review Analysts, Program Review Associates and Physician Consultants to ensure an appropriate and accurate process.
- Temp to perm
- Nassau County, NY
- Monday through Friday
- NO TRAVEL
- New Grads encouraged to apply!
- Immediate Start Date
- Conduct cost outlier reviews up to and including the appeal level. This includes voucher bill checks, screening pre-denials and final denials prior to electronic processing and accurate billing determinations
- Screen and complete electronic worksheets; enter required information and make additional requests when necessary
- Act as a resource for the PSC/clerical staff in training, problem solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles
- Act as a resource person to hospitals. Is responsible for ensuring appropriate and timely follow-up to inquiries
- Conduct training for peer review staff conducting intermittent cost outlier reviews.
- Other activities as may be deemed necessary
- Licensed as a Registered Professional Nurse in New York
- Knowledge and experience with electronic utilization chart review and DRG’s.
- Ability to oversee, problem solve and work collaboratively with Medicaid staff
- Excellent written and verbal skills
- Ability to work independently with little supervision
- Ability to relate effectively with medical and administrative staff as well as the public.
- Ability to be flexible, innovative and creative
- A minimum of two (2) years of experience in an acute care facility preferably in medicine/surgery or special care units; and/or one (1) to three (3) years of experience in acute care utilization review
- Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York.