[Hiring] Registered Nurse/Medicaid Clinical Reviewer @Greenlife Healthcare Staffing

Role Description

We are seeking an experienced Registered Nurse to join our team as a Medicaid Clinical Reviewer. This fully remote position involves conducting clinical reviews for Medicaid cases, ensuring compliance with state regulations, and contributing to quality improvement initiatives for a respected non-profit organization.

Work Schedule: Full-time, Monday to Friday (9:00 AM - 5:30 PM), Fully Remote

Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment

Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through quality Medicaid program oversight

Key Responsibilities

• Conduct utilization reviews up to and including the appeal level.
• Chart screen, complete electronic worksheets, enter required information, and make level one denial decisions when necessary.
• Conduct quality and clinical study data collection reviews.
• Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures.
• Participate in collaborative training specific to clinical study objectives.
• Use InterQual criteria to review medical records of inpatient high-cost hospital stays for admission and acute level of care.
• Review and validate itemized bills and write up responses to send to the hospital.
• Other activities as may be deemed necessary.

Qualifications

• Education: Graduate of an accredited nursing program
• Licensure: Active RN State license and active NY State License
• Experience: 1-3 years of experience in Case Review, Utilization, Billing, and coding review; InterQual and Milliman experience required. Must have at least 2 years of Med/Surg experience.
• Technical Skills: Proficiency with Microsoft Outlook, Word, and spreadsheets; comfortable working extensively on computer systems
• Soft Skills: Strong analytical skills, attention to detail, and ability to work independently in a remote environment

Requirements

• Competitive Compensation: Earn $45-$50 per hour based on experience

Benefits

• 1 Week Paid Vacation based on accruals
• 6 Major Paid Holidays per year
• 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act
• License Reimbursement after 1 year of employment
• Health insurance is subject to plan eligibility requirements
• 401k Matching eligibility after 1 year of employment
• Benefits from Paychex, such as Payactiv
• GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc