WCS Healthcare Partners | Local Contract Nurse RN - Clinic - $50-55 per hour - WCS Healthcare Partners

WCS Healthcare Partners is seeking a local contract nurse RN Clinic for a local contract nursing job in Queens, New York.

• Specialty: Clinic
• Discipline: RN
• Duration: 13 weeks
• 40 hours per week
• Shift: 8 hours, days
• Employment Type: Local Contract

Immediate opening for a Clinical Review RN, this position is remote but must report into Flushing on occasion. Must have experience with Chart Review, MLT, Claims and Denials.

Job Function:

• Day Shift


• 8:30am - 5pm


• Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made



• Excellent knowledge of all relevant PACE and applicable Federal and State regulatory requirements and guidelines, knowledge of CenterLight policies and procedures, and individual judgment and experience to assess the appropriateness of services, items provided, length of stay and level of care

  
  



• Collects relevant medical information and applies the appropriate evidence-based guidelines and medical policy for denied services associated with appeal cases

  
  



• Prepares cases for Medical Director Review or External Physician Advisor ensuring that all pertinent information

  
  

Job Requirements:

• Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred


• Current Nursing license


• 3-5 years’ clinical nursing experience, with 1-3 years in a managed care healthcare setting with experience clinical practice with experience in appeals & grievances or claims processing


• Knowledgeable about Medicare (CMS) PACE and Medicaid MLTC regulations demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Disclosure: The hourly rates and/or salaries listed may or may not reflect total compensation packages including bonus and fringe benefits, etc., nor are the advertisement(s) posted a guarantee of a certain compensation package for a position or bona fide offer of employment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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33490

White Cap Search Partners Job ID #33490. Posted job title: Local Contract - Rn - Clinical Review

With WCS Healthcare Partners, every Job Seeker grows stronger, moving one step forward with each job placement. We take the time to get to know the needs and qualifications of each Healthcare professional to match you with the right clinical setting, patient population, merging your compensation and career goals with your desired work environment. Our recruiters are experts at navigating the dynamic nature of healthcare employers to get your resume in front of the right decision makers.

NURSING

●      Registered Nurses (RN)

●      Licensed Practical Nurses (LPN)

●      Travel Nursing

●      Quality Assurance/Review, Performance Improvement, HEDIS

●      Nursing Leadership

●      Case Management

ALLIED HEALTH

●      Technologists: Medical, Laboratory, Cardiac, RadTech, X-Ray

●      Therapy: Physical, Occupational and Speech Therapy

●      Social Work: LCSW/LMSW, Case Management, Care Coordination

●      Med Support: Medical Assistants, Phlebotomy, Surgical/Sterile Techs

●      Pharmacists and Pharmacy Techs

●      Dental Hygienist, Dental Assistants

OPERATIONS & FINANCE

●      Practice Management

●      Clinical Operations

●      Administrative Support

●      Reception, Clerical, Call Center

●      Claims Appeals/Denials/Reimbursement

●      Insurance Pre-Authorizations

●      Medical Billing/Coding

• 401k retirement plan
• Weekly pay