Location: New York,NY, USA
VNS Health is seeking a Registered Nurse (RN) for Clinic Utilization Review in New York. As part of the role, you would resolve grievances, appeals, and external reviews for VNS Health Plans product lines. The position involves ensuring regulatory compliance, coordinating day-to-day operations, and maintaining accurate records. Additionally, you would be responsible for reviewing requests for prior authorization of health services and collaborating with various stakeholders to investigate and facilitate the resolution of grievances and appeals. The ideal candidate will have a minimum of three years of progressive professional experience in healthcare, including a minimum of two years in a grievance and appeals or related area. Other requirements include a current registration to practice as a registered professional nurse in New York State and proficient verbal/written communication skills. If you're passionate about contributing to the health and well-being of individuals in their own homes, VNS Health could be the perfect fit for you.