Nursing Facility Resolution Reviewer

2 weeks ago

Albany NY 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.

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