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About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers’ Compensation and other Casualty clients. The Workers’ Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager. Primary Responsibilities • Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work, • Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines, • Knowledgeable and compliant with New York State Workers’ Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process, • Proven ability to anticipate claimant's treatment or recovery milestones, • Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives, • Facilitates and expedites discharge planning as needed, • Produces accurate electronic records of individual cases, • Ensures timely, cost-effective medical care for injured workers' recovery, • Answers provider calls and assists with Casualty Department workload as necessary, • Kind, caring, and positive with all customers and fellow employees, • Adheres to established quality assurance standards and MagnaCare policies and procedures Essential Qualifications • Currently licensed Registered Nurse in the state of NY, or the ability to obtain, • Maintain current licensure(s) and specialty certifications that are relevant to this position; CCM is encouraged, • Minimum 1 year experience in worker’s compensation case management, • Bachelor’s degree preferred, • Minimum of 4 years’ experience in a clinical environment required, • Strong skills in medical assessment/medical record review, • Excellent customer service skills, • Ability to define and solve problems, collect data, establish facts and make effective decisions a must., • Must be detail oriented and have strong organizational and time management skills, and the ability to work independently., • Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Office, especially Word, Excel Teams, and Outlook Powered by JazzHR zEGYw9cEHB

Job DescriptionAbout The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers’ Compensation and other Casualty clients. The Workers’ Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager. Primary Responsibilities • Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work., • Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines., • Knowledgeable and compliant with New York State Workers’ Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process., • Proven ability to anticipate claimant's treatment or recovery milestones., • Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives., • Facilitates and expedites discharge planning as needed., • Produces accurate electronic records of individual cases., • Ensures timely, cost-effective medical care for injured workers' recovery., • Answers provider calls and assists with Casualty Department workload as necessary., • Kind, caring, and positive with all customers and fellow employees., • Adheres to established quality assurance standards and MagnaCare policies and procedures.Essential Qualifications, • Currently licensed Registered Nurse in the state of NY, or the ability to obtain., • Maintain current licensure(s) and specialty certifications that are relevant to this position; CCM is encouraged., • Minimum 1 year experience in worker’s compensation case management., • Bachelor’s degree preferred., • Minimum of 4 years’ experience in a clinical environment required., • Strong skills in medical assessment/medical record review., • Excellent customer service skills., • Ability to define and solve problems, collect data, establish facts and make effective decisions a must., • Must be detail oriented and have strong organizational and time management skills, and the ability to work independently., • Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Office, especially Word, Excel Teams, and Outlook. Powered by JazzHR zEGYw9cEHB

Job Description Requirements As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: • Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria, • Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision, • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes, • Provides copies of any criteria utilized in a review with the report in a timely manner, • Returns cases on or before the due date and time, • Makes telephone calls as mandated by the state and/or client specifics, • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job, • Attends all required orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits, • Board certification required, active practice required PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. Benefits • Robust opportunity for supplemental income, • Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability, • No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions., • Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise, • Expanded credentials as an expert in Independent Medical Exams and physician advisor services, • Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery. Apply for this job

Job Description As a Coding Reviewer, you will be responsible for the general coding validation and verification and preparation of independent dispute resolution reviews from external state and federal agencies in accordance with reporting requirements. Duties include but are not limited to: • Confirm and verify submitted codes for DRG validation., • Apply national coding standards and regulations to the claims and clinical data., • Provide subject matter input and support agency-wide projects., • Other duties as assigned. This position requires working on-site at the Jericho, NY office. Qualifications: • Excellent interpersonal and communication skills, both written and verbal., • Ability to relate effectively with technical, medical, analytical and administrative personnel., • Proficiency in EHR applications, office technology, and Microsoft applications including Word, Excel, and PowerPoint., • Being able to handle sensitive and confidential information., • Ability to work in a team environment and independently. Education & Experience: • Licensed Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS)/ Certified Coding Specialist Physician (CCS-P) required., • Technical knowledge of coding and DRG validation with CPT, HCPCS experience and ICD-10 certification required, • Bachelor’s degree in healthcare administration or health information management preferred., • Minimum of two (2) years of experience abstracting and coding of outpatient medical records for billing., • Some experience in utilization reviews preferred. The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $65,000.00 – $70,000.00. Actual salary range and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget. The salary range listed does not include other forms of compensation or benefits. IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status.