Legal Nurse Consultant (RN) (#10972) Job at GLHSTAFFING.COM
JOB TITLE: Job #10972 - Legal Nurse Consultant (RN) - New York, NY
GENERAL RESPONSIBILITIES:
This individual will complete the full spectrum of activities related to State and Federal Independent Dispute Resolution (IDR) case determinations. They will conduct a clinical-level review, Prior Authorization, and disputed benefits reviews, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process. You'll report directly to the Director/Assistant Director.
GENERAL RESPONSIBILITIES:
This individual will complete the full spectrum of activities related to State and Federal Independent Dispute Resolution (IDR) case determinations. They will conduct a clinical-level review, Prior Authorization, and disputed benefits reviews, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process. You'll report directly to the Director/Assistant Director.
Compensation for the Legal Nurse Consultant (RN):
- The salary for this position is $45 - $50 /per hour
Benefits: Competitive and Negotiable
Schedule:
Schedule:
- Full-time
- Monday to Friday (9 AM-5 PM)
- Saturday or Sunday meeting (occasionally)
- Contract Assignment
Requirements for Legal Nurse Consultant (RN):
- Licensed as a Registered Professional Nurse in New York State
- Legal Nurse Consultant Certification required
- Minimum of 3 years experience in Med-Legal review setting
- Knowledge and experience with electronic medical records
- Ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff
- Excellent written and verbal skills and has the ability to work independently with little supervision
- Ability and desire to be flexible, innovative, and creative
- Ability to meet deadlines in a time-sensitive environment
DUTIES:
- Conduct reviews up to and including the appeal level. This includes chart screens, 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 may be deemed necessary.
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