TITLE: Legal Nurse Consultant (RN)

LOCATION: Hybrid; New Hyde Park, NY 11042

Equipment will be provided in house (two monitors, PC, headset, camera)

GENERAL RESPONSIBILITIES:

This individual will complete the full spectrum of activities related to State and Federal Independent Dispute Resolution (IDR) case determinations. They will conduct clinical level review, Prior Authorization and disputed benefits review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.

DUTIES:

1. Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, complete electronic worksheets and preparing final determinations.

2. Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles.

3. Participate in collaborative training.

QUALIFICATIONS:

1. Licensed as a Registered Professional Nurse in New York State.

2. Knowledge and experience with electronic medical records.

3. Legal Nurse Consultant Certification required

4. Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.

EDUCATION & EXPERIENCE:

1. Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York.

2. Legal Nurse Consultant Certification required

3. A minimum of three years experience in Med-Legal review setting.