RN Nurse Reviewer
Horizon Healthcare Staffing is searching for a nurse reviewer for one of our clients located in Nassau County, NY. This is a temporary position. This individual is responsible for review for external appeals review for private sector clients, and assisting with other related nursing duties.
Location: Nassau county.
Hours: Monday- Friday 8:30am-5pm
- Responsible for the daily review of 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 the 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 a timely response.
- Participation in the 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
- NYS licensed Registered Nurse