Location: New Hyde Park, NY
Job Type: Full-time, On-site
Open to New Graduates No Clinical Experience Required
General Responsibilities:
We are seeking a dedicated and detail-oriented Registered Nurse (RN) to join our team full-time on-site in New Hyde Park, NY, as an Independent Dispute Resolution (IDR) Case Reviewer. In this role, you will manage the full spectrum of State and Federal Independent Dispute Resolution (IDR) case determinations, conduct clinical reviews, and assist with Prior Authorization and disputed benefits assessments. You will collaborate with Medical Review Analysts and Physician Consultants to ensure a thorough, accurate, and timely review process.
Duties:
- Conduct comprehensive case reviews, including appeals, by evaluating charts, regulatory guidelines, and insurance requirements.
- Complete electronic worksheets and prepare final determinations for IDR cases.
- Act as a key resource for administrative and clinical staff by providing guidance and assistance in problem-solving and determination clarification.
- Offer technical support, lead staff huddles, and participate in collaborative training sessions.
- Train and mentor new RNs as the project expands.
- Assist with claims assessment and adjudication processes.
- Perform other duties as required to support the department.
Qualifications:
- Strong knowledge of electronic medical records systems.
- Ability to work collaboratively with medical, analytical, and administrative teams to resolve complex cases.
- Excellent written and verbal communication skills.
- Capacity to work independently with minimal supervision.
- Flexible, innovative, and creative problem-solving mindset.
- Ability to meet deadlines in a fast-paced environment.
Education and Experience:
- Licensed Registered Nurse (RN) Required.
- Baccalaureate degree in Nursing or completion of an accredited Registered Professional Nurses training program Required.
- Open to new graduates with no prior clinical experience.