Nursing Facility Resolution Reviewer

3 weeks ago

Albany, United States IPRO Full time

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.

**Q**UALIFICATIONS**:

- 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 mínimal 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 annualized salary range for this position is $70,000.00 - $72,000.00. 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, sexual orientation, gender identity, national origin, disability or protected veteran status.

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