Nursing Facility Resolution Reviewer

2 months ago


Albany, United States IPRO Full time
Job Description

Based in Albany, working at the direction of the NYS Department of Health (DOH) you will be primarily responsible for the day-to-day case management of Nursing Facility Quality of Care Complaints. As a Nursing Facility Resolution Reviewer you 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. You will also participate in other resident protection activities as directed.

Qualifications

  • 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.

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The hourly rate for this position is $31.00 - $35.00/hr. Actual salary range and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range and/or hourly rate listed does not include other forms of compensation or benefits.

IPRO is an Affirmative Action/Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity or expresssion, disability, protected veteran status or military status.

  • Albany, United States IPRO Full time

    Job DescriptionBased in Albany, working at the direction of the NYS Department of Health (DOH) you will be primarily responsible for the day-to-day case management of Nursing Facility Quality of Care Complaints. As a Nursing Facility Resolution Reviewer you will interface with the resident &/or resident’s representative throughout the complaint resolution...


  • Albany, NY, United States IPRO Full time

    Job DescriptionBased in Albany, working at the direction of the NYS Department of Health (DOH) you will be primarily responsible for the day-to-day case management of Nursing Facility Quality of Care Complaints. As a Nursing Facility Resolution Reviewer you will interface with the resident &/or resident’s representative throughout the complaint resolution...


  • Albany, New York, United States IPRO Full time

    Job DescriptionAs a Nursing Facility Resolution Reviewer at IPRO, you will play a critical role in ensuring the quality of care for nursing facility residents. Based in Albany, you will work at the direction of the NYS Department of Health (DOH) to manage day-to-day case management of Nursing Facility Quality of Care Complaints. Your responsibilities will...

  • Registered Nurse

    1 month ago


    Albany, United States Greenlife Healthcare Staffing Full time $55

    JOB TITLE (#25154): Registered Nurse Clinical Reviewer / IDR - Lake Success or Albany, NYMinimum of 1-3 years of experience in utilization review/appeals backgroundGreenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer to fill an opening with a Non-profit organization located in Lake Success or Albany, New YorkRequirements of...


  • Albany, United States Greenlife Healthcare Staffing Full time

    Registered Nurse Clinical Reviewer / IDR - Lake Success or Albany, NY (#25154)Minimum of 3 years experience in a medical review settingGreenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer to fill an opening with a Non-profit organization located in Lake Success or Albany, New YorkSchedule of the Registered Nurse...


  • Albany, New York, United States GreenLife Healthcare Staffing Full time

    Medical Reviewer Job for Registered NurseWe are seeking a Registered Nurse with experience in medical review to join our team at GreenLife Healthcare Staffing. This is a full-time position with a 6-month contract, with the possibility of extension based on client demand and employee performance.Responsibilities:Conduct reviews up to and including the appeal...


  • Albany, New York, United States InGenesis Full time

    Job Title: Registered NurseInGenesis is seeking a highly skilled Registered Nurse to join our team in Albany, NY. As a key member of our client's team, you will be responsible for conducting medical reviews, investigating complaints, and developing investigative plans.Key Responsibilities:Perform medical reviews of clinical records to identify...


  • Albany, New York, United States The Boeing Company Full time

    Job DescriptionAt The Boeing Company, we are committed to innovation and collaboration to make the world a better place. Our team is seeking an experienced Manufacturing Liaison Engineer to support the review of AH-64 Apache tail rotor blade manufacturing processes.The Apache tail rotor blade is a high-performance aerodynamic, lightweight, hybrid metallic...


  • Albany, New York, United States Aureus Medical Group - Nursing Full time

    Aureus Medical Group - Nursing is seeking a travel nurse for a 12-hour overnight shift in a 766-bed facility located in Eastern New York.Specialty: CCU - Coronary Care ~ This facility offers a wide range of medical and surgical services. While on assignment, you'll be in a great spot to enjoy the outdoors.Specialty/Modality:RN-Coronary Care For this...

  • Clinical Reviewer

    4 weeks ago


    Albany, New York, United States Greenlife Healthcare Staffing Full time

    Job Title: Clinical Reviewer - Medical ProfessionalJob Description:We are seeking a skilled Clinical Reviewer to join our team at Greenlife Healthcare Staffing. As a Clinical Reviewer, you will be responsible for conducting reviews up to and including the appeal level, compiling regulatory guidance, researching insurer requirements, and preparing final...


  • New Albany, United States Baptist Healthcare System, Inc. Full time

    Job Description: Seeking Utilization Management RN! Full-time, days Baptist Health Floyd, Case Mangement Southern Indiana/Louisville, Kentucky area The Utilization Management Nurse completes utilization review on all assigned patients. He/she conducts review of admissions, length of stay, discharge, and services ordered and provided on a concurrent and...


  • New Albany, United States Baptist Health Full time

    Job Description:Seeking Utilization Management RN!Full-time, days Baptist Health Floyd, Case MangementSouthern Indiana/Louisville, Kentucky area The Utilization Management Nurse completes utilization review on all assigned patients. He/she conducts review of admissions, length of stay, discharge, and services ordered and provided on a concurrent and...


  • Albany, New York, United States NY CREATES Full time

    Job Summary:NY Creates is seeking a skilled Facility HVAC Technician to join our team. As a key member of our facilities team, you will be responsible for the maintenance and operation of our heating, ventilating, and air conditioning systems. Key Responsibilities:Maintain and repair heating, ventilating, and air conditioning systems, including boilers,...


  • Albany, New York, United States Preston Harris Group Full time

    We are seeking a highly skilled Medical Director to lead our skilled nursing facility team. As a Medical Director, you will be responsible for providing medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, and corporate requirements.Key responsibilities include:Performing...


  • Albany, New York, United States Please Contact for Facility Info Full time

    MedPro Healthcare Staffing is seeking a qualified travel nurse RN Med Surg for a contract nursing job in a top healthcare facility.Job Description & RequirementsSpecialty:Med SurgDiscipline:RNShift:12 hours, nightsEmployment Type:ContractMedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is seeking a quality Med-Surg registered nurse...


  • Albany, New York, United States RTG Medical-Nursing Full time

    RTG Medical-Nursing is seeking a travel nurse for a Cardiac Cath Lab position in a top-rated medical facility. Job Details Specialty: Cardiac Cath Lab Discipline: RN Employment Type: Travel As a travel nurse, you will have the opportunity to work in a dynamic and challenging environment, providing high-quality patient care and collaborating with a team of...


  • Albany, New York, United States Please Contact for Facility Info Full time

    Focus Staff is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in a top-rated facility.Job Description & RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNContract Assignment: 13 Weeks (Temporary)Shift: 3x12 DaysRewards: Competitive pay, health insurance coverage, 401K matching, new licensing reimbursement, and job...


  • Albany, New York, United States University At Albany Full time

    Job Title: Facilities Project ManagerWe are seeking a highly skilled Facilities Project Manager to join our team at the University at Albany. This is a promotional opportunity for current UAlbany employees.Job Summary:The Facilities Project Manager will be responsible for managing large capital construction projects to improve campus infrastructure and...


  • Albany, New York, United States Preston Harris Group Full time

    Job SummaryWe are seeking a highly skilled and experienced Medical Director to join our team at Preston Harris Group. As a Medical Director, you will be responsible for providing medical expertise and leadership to our skilled nursing facilities in the Albany NY region.Key Responsibilities:Provide medical review and expertise to ensure timely and quality...


  • Albany, New York, United States Quality Talent Group Full time

    About the job Licensed Practical Nurse - Skilled Nursing Facility We are seeking a motivated Licensed Practical Nurse to join our team at our Skilled Nursing Facility in Troy, NY. The ideal candidate will have a valid NY State LPN license and be in good standing with the State Registry. Responsibilities include collecting required information from new...