Rn chart review jobs in Uniondale, New YorkCreate job alerts

Job Description RN Clinical Reviewer / IDR - Remote to Office-Based Setting - Jericho, NY (#25293) • Location: Hybrid (Remote to Office-Based) - Jericho, NY, • Employment Type: Full-time, • Hourly Rate: For remote, it's $50/hr, and as soon as the candidate transitions into an office-based position, the rate will be increased to $60/hr About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. This hybrid role combines remote work with office-based responsibilities, focusing on conducting comprehensive medical-legal reviews and appeals for a respected non-profit organization. Why Join Us? • Work Schedule: Full-time, Hybrid (Remote to Office-Based), • Professional Growth: Gain valuable experience in medical-legal review and dispute resolution, • Impactful Work: Contribute to fair resolution processes in healthcare disputes Key Responsibilities: • Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations., • 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., • Participate in collaborative training, • Other activities as may be deemed necessary Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives Requirements Qualifications: • Education: Baccalaureate degree in Nursing or a graduate of an approved RN program., • Licensure: Current New York State RN license, • Experience:, • Must have at least 3 years of experience in a Med-Legal review setting., • Must have 1-3 years of experience in acute care utilization review/ appeals background., • Technical Skills: Experience with electronic medical records; strong research capabilities, • Competitive Compensation: For remote, it's $50/hr, and as soon as the candidate transitions into an office-based position, the rate will be increased to $60/hr., • Comprehensive Benefits:, • Paid Vacation (after 6 months of employment), • 6 Major Paid Holidays per year (after 6 months of employment), • 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, • 401(k) 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.

Job Description RN Clinical Reviewer (Proofer) - Jericho, NY (#25289) • Location: Jericho, NY, • Employment Type: Full-time, Temp-to-Hire, • Hourly Rate: $45/hr About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: Greenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Proofer Registered Nurse who will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their knowledge and expertise of the review program to conduct clinical-level review, supporting Medical Review Analysts and Physician Consultants to ensure an appropriate and accurate process. Why Join Us? • Work Schedule: Full-time (5 days per week), Temp-to-Hire position., • Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment, enhancing skills in clinical review., • Impactful Work: Play a critical role in ensuring the accuracy and integrity of state-level healthcare dispute resolutions. Key Responsibilities: This individual will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their knowledge and expertise of the review program to conduct clinical-level review, supporting Medical Review Analysts and Physician Consultants to ensure an appropriate and accurate process. • Conduct utilization reviews up to and including the appeal level. This includes the chart screen, complete electronic worksheets, entering required information, and making level one denial decisions when necessary., • Conduct quality and clinical study data collection reviews. This includes a chart review, complete detailed electronic data worksheets., • Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles., • Participate in collaborative training specific to clinical study objectives., • Other activities as may be deemed necessary. Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives Requirements Qualifications: • Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York., • Licensure: Must have an active NY State RN license., • Experience: Must have a minimum of 2 years experience in an acute care facility, preferably in medicine/surgery or special care units, and/or 1 to 3 years experience in acute care utilization review., • Technical Skills: Knowledge and experience with electronic medical records, including coding, quality, and clinical charting., • Soft Skills:, • Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff., • Excellent written and verbal skills., • Ability to work independently with little supervision., • Competitive Compensation: Earn $45 per hour., • Comprehensive Benefits:, • Paid Sick Time, • Health insurance, • 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.

Job Description:\n\nJOB SUMMARY: The Director of Wellness uses their specialized knowledge to insure the Resident’s care and management needs are being adequately and correctly met and assists the Executive Director, and the Director of Case Management as an additional liaison between Residents, the Residents Legal Representatives, their families, administrative staff, and community-based service providers. Responsibilities include the direct supervision of the Wellness and Reflections Unit; motivation, supervision and in-service training/education of the Resident Service Aides. The Director of Wellness will assure compliance with company policy and the State Health Department’s regulatory requirements for the admission and discharge procedure as well as appropriate documentation requirements. Additional responsibilities include: in-service education on health/wellness related topics and on the spot training to address identified performance concerns and/or improvements. As a member of a multi-disciplinary team the Director of Wellness facilitates development of the Resident’s individual plan of care under the direct supervision through collaboration with the Resident, the Resident’s family or Representative, the Resident’s primary care physician, the property Management Team, and any appropriate third-party providers. The Director of Wellness provides primary Resident supervision and acts as support to Residents, oversees admissions and discharges processes; provides orientation, social/emotional support, arranging for needed services; provides off-site visits and evaluations to residents in hospital and rehabilitation centers, and maintains Wellness/Reflections nursing notes as per company policy. DUTIES AND KEY RESPONSIBILITIES: 1. Administrative Services: a. Responsible for overall supervision of the Resident Services Department. i. The Director of Wellness will cross cover responsibility for the overall supervision of Wellness and Reflections b. Must be familiar with and able to implement emergency procedures as outlined in the Emergency and Disaster Plan. c. Responsible for the 24-hour, 7 days a week operation of the Wellness / Reflections Unit: i. Monitor proper scheduling and assignment of staff for Reflections Program in accordance with company policy and State Health Department regulations ii. Work collaboratively with RSC to ensure adequate coverage as needed in Wellness and Reflections d. Maintains on-going infection control surveillance, OSHA standards, universal precautions and basic sanitation and safety in Wellness Office and the Reflections Unit inclusive of the Resident’s apartments e. Assures the accuracy of Resident records and documentation in adherence with company policies as well as regulations of the State Department of Health f. Assures the medication management system adheres to State and local Department of Health laws and regulations and company policies, as well as Memory Care requirements: i. Assures thorough reviews of Medication Administration Records to include “chart to cart” audits, review of pre-MARs and final MARs. ii. Addresses all findings as a result of the review and develops appropriate training strategies to address such findings g. Follows the company policies and procedures related to incident reporting and notifications as well as State Department of Health Regulations i. Maintains incident report records ii. Informs Executive Director of all incidents h. Maintain active community and professional relationships to support positive promotion of the company. i. Develop contacts with community agencies serving senior citizens and clergy and refers residents where/when appropriate. ii. Maintain a liaison with facility and the community nursing homes, hospitals and assisted living facilities. i. Conducts, at the beginning of every shift, an observational walk-through of the entire Reflections Unit to insure no issue or concern needing immediate attention j. Conducts daily observational walk-through of the Main Dining Room/Reflections Dining Room to assure Residents are appropriately groomed and dressed k. Conducts supervised weekly scheduled checks of Reflections Resident’s apartments l. Performs other duties as assigned by the Executive Director. m. Monitor and maintain documentation on the Emergency Response System to ensure compliance, reporting findings to the ED as required 2. Resident Supervision: a. Acts as Resident advocate and assists Administrative staff in their continued service to the Resident i. Visits with each Resident to evaluate their concerns ii. Refers all Resident complaints and/or concerns to the Executive Director for immediate investigation and resolution b. Provides oversight to the admission process of the Resident to include: i. Appropriateness and accuracy of the Resident’s physician evaluation for sign off on same ii. Conducts (or delegates as appropriate) Initial Evaluation of Resident prior to admission into the community and follow-up evaluation as per company policy and State Department of Health regulations; • NJ only - If not licensed as an RN forwards Initial Evaluation to designated Registered Professional Nurse; iii. When indicated, assures completion of Behavioral Health evaluation as per company policy and State Department of Health regulation; iv. Provide initial and ongoing orientation to facility for new Residents; v. Acclimate Resident and introduces them to other Residents. vi. Encourage Residents to participate in social activities and insure that Wellness and Reflections front line staff is doing so also. c. Inform ED, Director of Case Management and Department Heads of the general well-being or Residents as well as their ability to live in the Assisted Living setting; d. Conduct as per company policy and State Department of Health requirements functional evaluations to identify Residents status and/or change in status and to determine the type and level of assistance needed: i. Develop and update each Resident’s service plan(s), evaluation, and other pertinent evaluations at specified intervals and when a change in Residents’ status warrants. • NJ only - If not licensed as an RN forwards all updated evaluations to the designated RN for sign off. ii. If delegated by ED, communicates change in Resident status to the Resident’s Representative and appropriate Administrative/Corporate Business staff; iii. Collaborate with a multidisciplinary team of providers, as well as the Resident and/or Resident’s Representative in the development of the Resident’s Individualized Service Plan on admission, appropriate revision within 30 days thereafter, and every 6 months; iv. Monitor the Wellness and Reflections Communication Logs daily for any unusual occurrences or changes in resident’s status and records and insures interventional strategies appropriately; v. Ensure all corporate policies and procedures and State Department of Health Regulations for Assisted Living Residences, Special Needs Program are followed and maintained; vi. Supervise Wellness and Reflections Unit staff to ensure that Residents receive appropriate care and activity program. vii. Ensure monthly support groups are conducted for families in the Reflections programs e. Coordinate care with the Department Heads, Resident’s physician, and other third-party providers: i. Collaborate with the Director of Case Management to assist residents with referrals to pertinent agencies when needed; i.e., Long Term Care insurance forms, nursing homes, social services agencies, Able Ride, etc. ii. Assist with hospital, skilled nursing facility, rehab centers, et al, with transfers and discharges and liaises external staff and discharge planner to determine suitability of Resident to return to facility: • Conduct off site visits as indicated/requested by ED/ Director of Case Management iii. Act as a liaison with Resident’s personal physician and other healthcare providers. iv. Refer Resident service problems to the appropriate Department Managers and Director of Case Management and Administration as necessary. f. Develop and keep accurate Resident records in compliance with company policy and regulatory rule: i. Collaborate in the development of the Resident service/care plans with Dietary Manager, (nutrition consult where indicated), Lifestyle Director, Director of Case Management, Resident’s primary care physician (and consultant specialists), third party providers (particularly home health) and the Resident’s family/Legal Representative; ii. Enter Wellness and Reflections Notes to include necessary social, recreational, physical, emotional, mental / behavioral health findings, needed and ordered interventions, and eventual outcomes iii. Review visiting and outside physician and provider notes and implement any changes in prescribed management as ordered by physician, g. Assure annual physician evaluations and where indicated behavioral health, pain, cognition, wander, fall, skin integrity evaluations; h. Oversee and document review of Residents who are self-administering medications to ensure continued competency and report all findings to ED, Director of Case Management, Resident’s physicians and Representatives – follow up as needed and indicated; i. Conduct skin observations on Residents, documenting findings to maintain compliance, and report findings for follow up. 3. Staff Education, Development, Supervision and Evaluation: a. At the request of the ED: i. Interview, recommend for hire and promotion, train, supervise, evaluate, discipline, and refer to ED for termination: ii. Supervise care staff as well as providing care to Residents iii. Conduct and/or schedule staff in-services to improve the quality of care by care staff to respond to both individual and global staff identified needs iv. Maintain in-service schedules to meet State Department of Health requirements as well as company policy v. Assure in-service training, competency observations vi. Assure Medication Aides are in compliance with all State Department of Health training, documentation of delegated tasks, and ongoing in-services requirements b. Assist in maintenance of personnel files including documentation of health evaluation, needed immunization and communicable disease clearances, certifications and/or licensure, et al; c. Conduct periodic health seminars for the Residents and/or Residents’ families in collaboration and coordination with the Lifestyle Director. d. Monitor and document scans of Electronic Health Records (EHR) and Emergency Response System to identify concerns, address findings, assure compliance and report findings to ED for follow up as needed e. Oversight of the staff audit process i. Conduct and monitor staff completion of audits including but not limited to: ERS, Controlled Substances, Medication Administration Records, Medication Carts, Resident medical files and Resident care ii. Report findings of the audits to the ED iii. Assist ED with plans of corrections based on findings; follow ups as required to ensure staff and findings are in compliance f. Follow all workplace injury procedures, including completion of reports for timely reporting and issuing corrective action when necessary. g. Adhere to and uphold company policies and procedures. 4. All other tasks as assigned by supervisor. QUALIFICATIONS: · Associate Degree at a minimum, Licensed Professional Nurse, preferred Bachelor Degree in Social Services, Nursing, Geriatric Health Services, Activities/Recreation or related field · Minimum of three (3) years’ experience working with the Alzheimer/dementia geriatric population · Experience managing care staff and medication technicians · Working knowledge of medical and nursing terminology · Level of proficiency with Microsoft Office and email · Some training or experience in use of computerized filing/data base management systems. · Ability to speak clearly and comfortably to and deal courteously, compassionately, and efficiently with Residents, Residents families, physicians, property personnel, and others · Ability to use discretion in handling confidential information · Ability and flexibility to tolerate frequent work interruptions, organize work and re-set priorities in order to complete work responsibilities in a timely manner; · Must be emotionally, mentally and physically able, with or without reasonable accommodations, to provide required services to residents, including verbally communicating with residents. · Must be able to speak, read, and write in English, which is the predominant language of a majority of our residents. · Must be able to listen attentively to residents' requests and preferences, ensuring exceptional customer service. · Excellent communications skills both verbal and written · Knowledge and demonstrated performance of in-service procedures. · Must complete all required annual trainings as directed. WORKING CONDITIONS & PHYSICAL REQUIREMENTS: · Responsible for the 24-hour, 7-day a week operation of the Wellness Department (Director of Wellness) · Responsible for the 24-hour, 7-day a week operation of the Reflections Unit - Special Needs Program. · Available and responsive to staff and/or Management and/or Residents families/providers for immediate consultation 24/7 and for off shift, on site visits to building when necessary. · Shift changes may be required depending on the needs of the Wellness Department and/or Reflections Unit · · Exposure to blood borne pathogens and body fluids. · Communication with Residents, Residents Families, physicians and other licensed providers · Acute sense of smell and intuitive nature · Listening for falls, cries, choking, door alarm, etc., 100% · Bending, squatting, kneeling and lifting occasionally. · Climbing stairs occasionally · Driving to off-site facilities/locations WORKING CONDITIONS: · Standing 10% · Walking 20% · Sitting 30% · Talking 30% · Driving 10% I have read and understand this position description thoroughly and will assume the responsibilities as indicated. I further understand that I may not refuse to do a job or task that is required to meet the standards of quality Resident care. I can perform these duties and responsibilities without accommodation: q Yes q No I will need the following accommodation to perform these tasks: Team Member’s Signature Date

IDR cases per dayreviewing documentation, codes, and costs. Conduct reviews up to and including the appeal levelincluding chart screening, regulatory guidance, insurer requirements, electronic worksheets, and final determinations. Clinical Review RN (Independent Dispute Resolution).