Clinical Utilization Review Nurse
1 month ago
VNS Health is seeking a Clinical Utilization Review Nurse for a nursing job in Manhattan, New York.
Job Description & Requirements- Specialty: Utilization Review
- Discipline: RN
- Start Date: ASAP
- Duration: Ongoing
- Employment Type: Staff
We are looking for a detail-oriented and experienced Clinical Utilization Review Nurse to join our team. The successful candidate will be responsible for resolving grievances, appeals, and external reviews for VNS Health Plans product lines, ensuring regulatory compliance, and coordinating day-to-day operations according to defined processes and procedures.
What We Provide- Attractive sign-on bonus and referral bonus opportunities
- Generous paid time off (PTO) and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life, and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Develop and maintain current knowledge of state and federal regulatory requirements related to grievances and appeals
- Investigate and review routine and complex situations and underlying issues
- Coordinate the resolution of routine and complex grievances and appeals according to defined processes and procedures
- Review covered and coordinated services in accordance with established plan benefits and application of medical criteria
- Collaborate with professionals, health plan departments, and legal as necessary to investigate and facilitate resolution of individual grievances and appeals
- Provide input and recommendations for the design and development of policies, processes, and procedures for improved department operations and customer service
Licenses and Certifications:
- License and current registration to practice as a registered professional nurse in New York State required
Education:
- Bachelor's Degree in Nursing required
- Master's Degree in Nursing preferred
Work Experience:
- Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required
- Proficient computer and typing skills and knowledge of Microsoft Office (Word and Excel) required
- Ability to work in a fast-paced environment and effectively manage multiple grievances and appeals simultaneously
About VNS Health: VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. On any given day, more than 10,000 VNS Health team members deliver compassionate care and 24/7 solutions and resources to the more than 43,000 neighbors who look to us for care. VNS Health offers a full range of health care services, solutions, and health plans designed to simplify the health care experience and meet the diverse and complex needs of those we serve in New York and beyond.
Benefits- Guaranteed Hours
- 401k retirement plan
- Employee assistance programs
- Dental benefits
- Vision benefits
- License and certification reimbursement
- Life insurance
- Discount program
- Holiday Pay
- Continuing Education
- Wellness and fitness programs
- Mileage reimbursement
- Medical benefits
- Benefits start day 1
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