What are the responsibilities and job description for the Utilization Management Appeals Nurse 210559 position at Medix™?
Job Title: Utilization Management / Appeals Registered Nurse
Job Details
- Posting Date: 4/16/2025
- Reference ID: 210559
- Locations: New Hyde Park, NY
- Work Location: Onsite
- Discipline: Nursing / Utilization Management
- Job Type: Contract to hire
- Salary Expectations: $50 - $54/hour
- Schedule/Shift: Monday to Friday, 8:00 AM – 5:00 PM
Job Description
Responsibilities/Job Duties:
- Conduct reviews for State and Federal Independent Dispute Resolution (IDR) case determinations, including prior authorizations and disputed benefit reviews.
- Review medical charts, compile regulatory guidance, research insurer requirements, and complete electronic worksheets.
- Prepare final determinations for disputed claims and appeals.
- Act as a resource for administrative and clinical staff by offering training, technical assistance, and conducting staff huddles.
- Mentor and train new RNs as the project expands.
- Assess and adjudicate claims, ensuring accuracy and compliance with regulations.
- Participate in collaborative training sessions and staff meetings.
- Handle a mix of simple and complex cases, reviewing documentation and coding for out-of-network bills to determine next steps.
Minimum Education and Experience Qualification Requirements:
Education:
- Baccalaureate degree in Nursing (BSN) required.
- Graduate of an approved Registered Professional Nursing program.
- New York State Registered Nurse License
Experience:
- Minimum of 2 years in a clinical setting.
- Knowledge of Utilization Management, Appeals, or Clinical Documentation PREFERRED
- Familiarity with electronic medical records (EMR) systems.
Salary : $50 - $54
