Appeals and Grievances Nurse Specialist

One of the region's fastest-growing health plans is looking for an experienced Appeals and Grievances Nurse Specialist who is seeking an exceptional career opportunity with the benefit of working from the comfort of his/her own home.

After training in the New York City office, this position will telecommute most of the time with occasional onsite meetings. 

In this position you will:

• Ensure that appeals and grievances are categorized and processed within New York State and Federal timeframes
• Enter all appeals and grievances in the software tracking system
• Identify potential quality issues and initiate investigations when needed
• Refer substantiated quality of care issues to the quality improvement and provider relations areas
• Maintain absolute file integrity with regard to content, location, and confidentiality
• Prepare for and participate in regulatory site visits 
• Assist with training of new department employees and act as a subject matter expert for the care management department
• Communicate with all relevant departments to gather data and information to support timely review of appeals and grievances  

Please be advised that we are only considering nurses with the following:

• Current RN Licensure in New York State
• Associates of Science Degree in Nursing
• Minimum 2 years clinical nursing experience in a medical-surgical environment
• Minimum 2 years experience in appeals and grievances, claims processing, or utilization management in a managed care organization
• Understanding of MLTCP program requirements and Utilization Review Guidelines (NYS ART 44 and 49 PHL)
• Exceptional computer, communication, and writing skills
• Must reside within 50 mile radius of job location to be eligible for telecommuting position

What is it really like to work for one of the fastest growing health plans?

Here’s what others have to say...
 

"I enjoy the flexibility my position affords me."

"The company has shown me they care about me as an individual."

"I like working here because of the competitive salary and benefits offered."

"I enjoy working with my colleagues and bosses. I am respected as an individual and as a professional."

Generous Benefits Including Performance Bonus! 

This rapidly growing award winning managed care organization is committed to maintaining a challenging environment that promotes personal growth and an active and rewarding role in fulfilling the goals of the organization.  They recognize that Appeals and Grievances Nurse Specialist is a critical part of providing affordable quality care to its members and are happy to offer the individual in this position these generous benefits:

* 23 days paid time off

* Choice of three medical plans, plus dental and vision

* 403(b) retirement and 401(k) with company match

* Flex spending account

* Short term and long term disability

* Life insurance

* Performance bonus

How Pathway Medical Works with You to Get the Job 

Since 1998 we have focused exclusively on helping case managers and related non-bedside nursing professionals find career opportunities that fit their lifestyle and advance their careers.
 

* We have long standing relationships with nurse executives at dozens of leading healthcare organizations, ensuring that your accomplishments and skills get noticed by key decision makers.    

* We will review your resume to make certain it emphasizes the important skills and experience requirements of the job for which you are applying. 

* We will then prepare you for your interview , enabling you to show why you are the best candidate for the job.

* When an offer is extended we will help you negotiate compensation, benefits and any additional employment issues.

We look forward to receiving your application for the Appeals and Grievances Nurse Specialist opportunity with this exceptional organization.  Please click on the "Apply Now" button to submit your resume for consideration.