Registered Nurse/Medicaid Clinical Reviewer | Remote | Up to $50/hr

Registered Nurse/Medicaid Clinical Reviewer - Remote (#25291) Location:Remote Employment Type: Full-time Hourly Rate: $45/hr - $50/hr Position Overview: We are seeking an experienced Registered Nurse to join our team as a Medicaid Clinical Reviewer. This fully remote position involves conducting clinical reviews for Medicaid cases, ensuring compliance with state regulations, and contributing to quality improvement initiatives for a respected non-profit organization. Why Join Us? • Competitive Compensation: Earn $45-$50 per hour based on experience • Comprehensive Benefits: • Paid Vacation based on accruals • 6 Major Paid Holidays per year • 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act • License Reimbursement after 1 year of employment • Health insurance is subject to plan eligibility requirements • 401k Matching eligibility after 1 year of employment • Benefits from Paychex, such as Payactiv • GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc • Work Schedule: Full-time, Monday to Friday (9:00 AM - 5:30 PM), Fully Remote • Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment • Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through quality Medicaid program oversight Qualifications: • Education: Graduate of an accredited nursing program • Licensure: Active RN State license and active NY State License • Experience: 1-3 years of experience in Case Review, Utilization, Billing, and coding review; InterQual and Milliman experience required • Technical Skills: Proficiency with Microsoft Outlook, Word, and spreadsheets; comfortable working extensively on computer systems • Soft Skills: Strong analytical skills, attention to detail, and ability to work independently in a remote environment Key Responsibilities: This individual will complete the full spectrum of activities related to Medicaid Utilization or Quality reviews as assigned. Thus, conduct final level insurance appeals and review medical records. Responsibilities for Registered Nurse/Medicaid Clinical Reviewer - Remote • Conduct utilization reviews up to and including the appeal level. This includes chart screen, completing electronic worksheets, entering the required information, and making level one denial decisions when necessary. • Conduct quality and clinical study data collection reviews. • Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. • Participate in collaborative training specific to clinical study objectives. • You will be using InterQual criteria to review the medical records of inpatient high cost hospital stays for admission and acute level of care. • You'll also review and validate itemized bills and need to have the ability to write up responses to send to the hospital. • Other activities as may be deemed necessary Remote Skills: Analysis Skills, Billing, Clinical Data Collection, Clinical Nursing, Clinical Training, Clinical Trial, Clinical Validation, Code Reviews, Computer Systems, Detail Oriented, Employee Retention, Health Insurance, Healthcare Quality, Hospital, Insurance, Maintain Compliance, Medicaid, Medical Records, Microsoft Outlook, Microsoft Word, Nonprofit, Nursing, Nursing Credentials, Patient Care, Problem Solving Skills, Quality Assurance, Quality Management, Quality of Care, Registered Nurse (RN), Regulatory Compliance, Reimbursement, Spreadsheets, Staff Training, State Laws and Regulations, Team Player, Utilization Management, Writing Skills About the Company: Greenlife Healthcare Staffing Apply tot his job