Registered Nurse/Medicaid Clinical Reviewer Job at Greenlife Healthcare Staffing, New York, NY

WDBJS2lNQ3UwUUZQOTJNMFVKYTQ3c3FTUGc9PQ==
  • Greenlife Healthcare Staffing
  • New York, NY

Job Description

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

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.

Responsibilities:

  • 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

About Greenlife Healthcare Staffing:

We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming.At Greenlife our mission is to make this process easier for you and help you through all the steps necessary to find that perfect new position or the healthcare professional to round out your team.We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.

Job Tags

Hourly pay, Full time, Monday to Friday,

Similar Jobs

GreatAuPair LLC

Au Pair Job at GreatAuPair LLC

Looking for a live in nanny who can do the following: Feed and wash bottles Laundry including folding and putting away, meal prep for his foods, engaging in age appropriate activities, occasional bed time and bath time. Refilling diaper bins and being proactive on chores...

Asset Management Associates of Medford

Wealth Management Intern (Paid Internship) Job at Asset Management Associates of Medford

 ...Financial Planning Services is seeking a motivated and detail-oriented Wealth Management Intern to support our investment, financial planning, marketing, and technology teams. This paid internship offers hands-on exposure to the day-to-day operations of a wealth... 

CRH

Ready Mix Driver Job at CRH

 ...Division, part of CRH South Division, is a leading supplier of ready mix concrete, concrete block, rebar and building materials in the state...  ...their own safety. We are seeking experienced Ready Mix Drivers for our Florida operations in Hudson, FL. Primary Job... 

VDart Inc

Test Rail Admin Job at VDart Inc

 ...Role: Test Rail Admin Location: Canada, Remote Duration: 2-3 Months System Configuration: Maintain the TestRail platform, ensuring it aligns with organizational QA workflows and project milestones. User & Security Management: Manage user access,... 

Ampersand Therapy

Speech Language Pathology Assistant (SLPA) Job at Ampersand Therapy

 ...Speech Language Pathologist Assistant (SLPA) School-Based | 2025-2026 SY Location: Tacoma, WA Job Type: Full-Time, In-Person, W-2 Employee About the Role: Ampersand Therapy is a therapist-founded, woman-owned company seeking full-time Speech Language Pathologist...