Registered Nurse

Job Title : Utilization Management / Appeals RN (BSN)

Experience : Strong analytical / clinical background, UM, UAS, or Appeals experience

Appeals experience not required, open to various backgrounds / experience

Location : Onsite required; office in Lake Success / New Hyde Park, NY

Hours : M-F 7a-5p

• flexible schedule

Start date : ASAP

Pay : $48-54 / hr

Education : Must have BSN

Volume : Will do appeals work under the IDR team handling on average 10 cases a day. These will be a mix between simple and complex cases. They will be reviewing documentation, codes, and more for out of Network bills and cost and making determinations on how to move forward based on the evidence.

For California Applicants :

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.