Remote UM / Grievance & Appeals RN NY Licensed

Now hiring: Remote UM / Grievance & Appeals RN (NY License) | Contract | $52–56/hr

Are you an RN who has owned appeals cases from intake to final decision letter? We want to talk to you.

Our client, a New York health plan, needs a clinical Grievance & Appeals nurse with a utilization management or case management background. You’ll review medical necessity for outpatient and community-based services such as home health, long-term care, DME and outpatient procedures. You’ll also work with the Medical Director, write determination letters, and prepare cases for Fair Hearings and CMS external reviews.

What you need:
Active, unrestricted New York RN license
2+ years of payer-side grievance & appeals experience, where you made or drafted the clinical decision
UM or case management experience (InterQual/MCG)
Outpatient, home health or LTC experience (not inpatient-only)
Knowledge of CMS and/or NY Medicaid/MLTC appeals rules

What you get:
100% remote
$52–56/hour, depending on experience
Contract role with a respected health plan

If this sounds like you, apply below or send me a message. If you know a G&A nurse who’d be a great fit, please tag them.

#NurseJobs #UtilizationManagement #AppealsNurse #RemoteNursing #ManagedCare #NYRN