Medical Reviewer conducting medical claims reviews for BlueCross BlueShield of South Carolina. Working onsite initially then transitioning to remote after training period.
About the role
- Registered Nurse Clinical Reviewer performing medical-legal reviews and appeals at Greenlife Healthcare Staffing. Hybrid role requiring both remote and office-based tasks in New York.
Responsibilities
- Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations.
- Act as a resource for the administrative and clinical staff in training, problem-solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles.
- Participate in collaborative training
- Other activities as may be deemed necessary
Requirements
- Education: Baccalaureate degree in Nursing or a graduate of an approved RN program.
- Licensure: Current New York State RN license
- Experience:
- Must have at least 3 years of experience in a Med-Legal review setting.
- Must have 1-3 years of experience in acute care utilization review/ appeals background.
- Technical Skills: Experience with electronic medical records; strong research capabilities
- Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills
Benefits
- Competitive Compensation: For remote, it's $50/hr, and as soon as the candidate transitions into an office-based position, the rate will be increased to $60/hr.
- Comprehensive Benefits:
- Paid Vacation (after 6 months of employment)
- 6 Major Paid Holidays per year (after 6 months of employment)
- 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act
- License Reimbursement after 1 year of employment
- Health insurance is subject to plan eligibility requirements
- 401(k) Matching eligibility after 1 year of employment
- Benefits from Paychex, such as Payactiv
- GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.
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Performs medical reviews and utilization management of facility benefits at BlueCross BlueShield. Responsible for documentation and support of medical claims and utilization practices.
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