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Clinical Appeals RN

MJHS Type Full time Posted 1/13/2014
Salary - n/a - Starts 4/21/2014
NY - New York (All) - Brooklyn Referral - n/a -    
 
  We believe that nurses give their best care when they know they are being cared for too. When you work for MJHS, you’ll be valued and respected for your dedication to world-class patient care. You’ll be encouraged and challenged to learn and grow. Most of all, you’ll be rewarded with work/life programs that help you balance your priorities and enjoy the career you’ve always wanted. You won’t find that everywhere. But you will find it here.  
 
 
Title:  Clinical Appeals RN
Program:  Elderplan
105687
Nursing - Managed Care
 
 
BROOKLYN
Job Description:
The Clinical Reviewer will perform retrospective medical necessity and clinical documentation reviews for provider and vendor appeals. 

We truly value our staff and further acknowledge their contributions by offering:
  • Employee and family health coverage
  • Competitive salaries
  • Employer contributed pension plan
  • Generous time off
  • Employee tuition reimbursement
  • Dependent tuition reimbursement
  • 403(b) retirement plan
Job Requirements:
  • A Bachelor’s degree and an active NYS RN License is required.
  • Minimum of Five (5) years experience with strong case management, utilization reviiew, coding or fraud investigation is required.
  • Working knowledge of Microsoft Office Word, Excel, Power Point and GroupWise is required.
  • Must have excellent written ad verbal communication skills.
  • Must be comfortable researching current evidence based practice guidelines and protocols.
  • Must be able to multi-task and managed multiple projects efficiently, meet deadlines, demonstrate analytical/critical thinking skills, and provide excellent customer services that leads to positive problem resolution.
 
 

We are an equal opportunity employer M/F/D/V.

www.mjhs.jobs