Nursing Facility Resolution Reviewer (RN req'd)- Part Time
Based in Albany, working at the direction of the NYS Department of Health (DOH) this individual is primarily responsible for the day-to-day case management of nursing facility Quality of Care Complaints. S/he will interface with the resident &/or resident’s representative throughout the complaint resolution process including assisting with alternative dispute resolution; communication with the nursing facility; case processing including preparation of correspondence & assistance with mediation; medical record review & related activities to assure compliance with timelines & confidentiality regulations. This individual may also participate in other resident protection activities as directed.
Strong interpersonal skills are desirable to facilitate positive customer satisfaction in situations that are adverse or in controversy.
Excellent communication (verbal & written) skills.
Ability to work independently with minimal supervision.
Ability to relate effectively to providers, physicians, senior medical & administrative personnel & residents/patients.
Strong computer skills with the ability to learn new programs.
The ability to obtain Surveyor Minimum Qualifications Test (SMQT) certification within 12 months of employment, required.
Able to travel to on-site facility review assignments.
EDUCATION & EXPERIENCE:
NYS Licensed RN, required.
Graduate of an approved, registered professional nursing program, required. A Bachelor’s degree in Nursing, preferred.
Two (2) years’ experience performing utilization review, claims adjudication, medical review, fraud investigation, surveillance or monitoring activities; OR
Three years of clinical or administrative experience, required
SMQT Certification, preferred.
IPRO offers competitive salaries, comprehensive health and dental coverage.
IPRO is an Affirmative Action/Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status
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