Utilization review nurse jobs in Glen Cove, New YorkCreate job alerts

Job Description New Rochelle Region - Become SMQT Certified! $3,000 Sign-on Bonus Based in New Rochelle, the Nursing Home Surveyor/ Complaint Investigator will assist the New York State Department of Health (NYSDOH), Office of Aging and Long-Term Care, with surveillance and investigation activities related to nursing homes (long term care). These activities are mandated to evaluate facility performance and monitor the quality of care and services provided. In this role you will participate as a member of an interdisciplinary survey/investigation team to review allegations of abuse and neglect, perform surveillance activities/tasks at nursing homes (long term care)/Transitional Care Units (TCUs), and Adult Day Health Care Programs (ADHCP) to determine compliance with the requirements of participation; prepare written reports of investigative findings and prepare Statement of Deficiencies (SOD) within required time frame, using Principles of Documentation. participate in emergency surveys at Skilled Nursing Facilities (SNF’s); participate in State monitoring during Immediate Jeopardy situations; as well as other duties. This position is majority travel, will be onsite at facilities in Sullivan, Orange, Dutchess, Putnam, Rockland, Ulster and Westchester counties. Mileage and accommodation reimbursement provided. Non-travel days are based out of the NYSDOH New Rochelle office -OR- telecommuting, if approved. QUALIFICATIONS: • Demonstrate strong interpersonal skills with the ability to facilitate positive customer satisfaction in situations that are adverse or in controversy., • Ability to successfully work independently with minimal supervision, as well as in a team environment., • Excellent written and verbal skills with the ability to communicate professionally with co-workers, supervisors, providers, medical and administrative personnel, and residents/patients., • Ability to translate collected information into a clear, concise, legal, and defensible document., • Excellent investigative and analytical skills., • Strong computer skills with working knowledge of Microsoft office products, and the ability to learn new programs., • Ability to obtain Surveyor Minimum Qualifications Test (SMQT) certification within 12 months of employment, required., • If approved to work remotely, must have secure internet that meets the speed required to perform all work duties, must have workspace that provides privacy for all work-related calls, and must be able to secure all work-related items when not in use., • NYS Licensed and registered, Licensed Practical Nurse, graduate from an approved practical nursing program, required., • A minimum of two (2) years of experience in performing utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, OR minimum of (2) years of clinical experience in a licensed health care facility, required. The salary range and/or hourly rate 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, or any other category protected under applicable law.

Job Description In the Clinical Reviewer RN (Proofer) role, you will review all NYS Dispute Resolution and External Review determinations for accuracy of decisions, mathematical determinations, content, grammar, punctuation and state required conventions. The Clinical Reviewer RN (Proofer) will utilize their clinical knowledge and editorial skills to produce a final, clean copy for each case determination. This individual will track errors and retrain clinical and administrative staff to mitigate production errors. This position is based in IPRO's Headquarter office located in Jericho, NY. QUALIFICATIONS: • Evidence of medical proofing, editing skills including professional writing and/or publishing., • Knowledge and experience with electronic medical records including coding, quality, and clinical charting., • Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff., • Excellent communication and verbal skills., • Ability to work independently with little supervision., • Ability and desire to be flexible, innovative, and creative., • Licensed as a Registered Professional Nurse in New York State., • Bacholer's degree in Nursing OR graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York, required. The salary range and/or hourly rate 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, age, disability, protected veteran status or military status, or any other category protected under applicable law.

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 In this Supervisor role you will assist IPRO’s Senior Director and the New York State Department of Health (NYSDOH), Office of Aging and Long-Term Care, Long Term care, with oversight of surveillance and investigation activities related to nursing homes (long term care). These activities are mandated to evaluate facility performance and monitor the quality of care and services provided. Duties include but are not limited to ensuring the quantity and quality of IPRO staff work output with acceptable outcomes; working with IPRO’s designated staff to ensure correct invoicing are submitted for staff; coordinating and assisting in providing preceptor surveillance training to IPRO surveyors; participating as a member of an interdisciplinary survey team and producing written documentation and draft Statements of Deficiencies (SOD); attend meetings and other duties assigned. The position will be located at the NYS DOH lower Manhattan OR Central Islip office. Non-travel days are based at the designated office or telecommuting, if approved. QUALIFICATIONS: • Demonstrate strong interpersonal skills with the ability to facilitate positive customer satisfaction in situations that are adverse or in controversy., • Ability to successfully work independently with minimal supervision, as well as in a team environment., • Excellent written and verbal skills with the ability to communicate professionally with co-workers, supervisors, providers, medical and administrative personnel, and residents/patients., • Ability to translate collected information into a clear, concise, legal, and defensible document., • Excellent investigative and analytical skills., • Strong computer skills with working knowledge of Microsoft office products, and the ability to learn new programs., • If approved to work remotely, must have secure internet that meets the speed required to perform all work duties, must have a workspace that provides privacy for all work-related calls, and must be able to secure all work-related items when not in use., • Must have a valid driver’s license & the ability to travel to on-site facilities review assignments. EDUCATION & EXPERIENCE: • NYS Licensed, Registered Nurse, required., • A minimum of two (2) years of experience in performing utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, OR, three (3) years of clinical or administrative experience, OR A bachelor’s degree in nursing and two (2) years of clinical or administrative experience and two (2) years of supervisory experience., • Surveyor Minimum Qualifications Test (SMQT), required. 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 salary range for this position is $109,750.00- $115,996.50. Actual salary range and /or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget. The salary range and/or hourly rate 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, age, disability, protected veteran status or military status or any other category protected under applicable law.

Job DescriptionRegistered Nurse – Nursing Home Surveyor / Complaint Investigator – New Rochelle, NY (#25141) Location: New Rochelle, NY Employment Type: Contract / Travel Hourly Rate: $45/hour About Greenlife Healthcare Staffing Greenlife Healthcare Staffing is a leading national recruitment agency committed to connecting skilled healthcare professionals with premier job opportunities. We partner with hospitals, nursing homes, clinics, and private practices to place candidates in roles that align with their career goals. Position Overview We are currently seeking an experienced Registered Nurse – Nursing Home Surveyor / Complaint Investigator for a Review Company based in New Rochelle, NY. In this dynamic contract/travel role, you will conduct regulatory compliance surveys, investigate complaints (including abuse/neglect), and help ensure safe, quality care in long-term care settings. Key Responsibilities • Conduct surveys, complaint investigations (including abuse/neglect), and surveillance in long-term care facilities, • Draft Statements of Deficiencies (SODs) using Principles of Documentation, • Evaluate compliance with Plans of Correction within required timelines, • Input findings into federal and state databases, • Participate in state monitoring during Immediate Jeopardy cases, • Attend staff meetings and provide testimony in administrative hearings as needed, • Comply with DOH schedules, policies, and procedures, • Travel to assigned facilities based on your work schedule Greenlife Healthcare Staffing Empowering Healthcare Professionals. Enriching Lives. Requirements Qualifications Education & Licensure: • Bachelor's degree in Nursing (preferred), • 2+ years of experience in utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, • 3+ years of clinical or administrative nursing experience, • BSN + 2 years of clinical or administrative experience, • SMQT Certification preferred (must obtain within 12 months), • ???? Competitive Pay: $45/hour, • ???? Mileage Reimbursement for travel, • ???? Flexible Schedule, • ✈️ Contract/Travel Position with real-world impact

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 As a Clinical Reviewer, you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You 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. Duties include but are not limited to: • Conduct utilization reviews up to and including the appeal level. This includes chart screen, complete electronic worksheets, enter required information and make level one denial decisions when necessary., • Conduct quality and clinical study data collection reviews. This includes 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., • Knowledge and experience with electronic medical records including utilization, quality, and clinical charting., • 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., • Ability and desire to be flexible, innovative, and creative. EDUCATION & EXPERIENCE: • New York State, Licensed Registered Nurse, required., • A bachelor’s degree in Nursing OR graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York, required. The salary range and/or hourly rate 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, or any other category protected under applicable law.

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? • 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., • 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. 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., • Ability and desire to be flexible, innovative, and creative 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

Job DescriptionSalary: $20 hourly About Us: Tribeca Pediatrics was founded by Dr. Michel Cohen, in 1994, and has grown into New York City's largest and most respected primary care pediatric practice. With over 50 locations in vibrant neighborhoods throughout the New York City metro area and New Jersey, our incredible team of pediatricians, nurse practitioners, and clinical support staff practices a unique philosophy that embraces low intervention and thoughtful medicine while delivering the highest quality of service and care. About the Role: Our Medical Assistants provide direct patient care to children in a clinical setting. They team up with our pediatricians to provide a high level of service and care. Expectations include the following: • Maintain a friendly, supportive, and professional demeanor with patients and colleagues, • Patient intake, charting, and documentation in our electronic medical records system, • Measure vitals, perform in-office tests and surveys, send out labs, • Assist with vaccine administrations, • Schedule appointments, • Welcome patients, take on front desk responsibilities, • Maintain vaccine and supply inventories, • Adhere to practice policies around HIPAA compliance and staff and patient safety, • Exceptional customer service skills, • Previous experience in the medical field preferred (pre-med & CMA new grads also welcome), • Time management skills and ability to multitask, • Flexible scheduling availability, • Must be able to provide proof of vaccination against Hep B, Tdap, and MMR Compensation and Benefits: Medical Assistants start at $20/hour for their first year with us! We conduct our own in-house Medical Assistant training (3-4 weeks long), which is fully covered at your hired pay rate. • Additional monthly incentive bonuses tied to productivity, utilization, and attendance offered, • Potential assignment as a trainer after 90 day review, training bonus offered, • Annual evaluations with compensation increases, • Opportunity for upward mobility and promotion within the company Paid Time Off: Full-time employees accrue 10.67 hours per month (approximately 16 PTO days per year) Health, Dental, and Vision Benefits: Full time employees are eligible to participate in the health, dental, and vision insurance plans after 90 days of service. The base level plans are covered 100% by the company. Other level plans include a subsidy from the company. Additional Benefits: Additional benefits include entirely subsidized (read: free to you!) gym memberships at your choice of NY Sports Club, Blink Fitness, and LA Fitness. As well as others that include: an HSA plan, pet insurance, commuter benefits, voluntary supplemental insurances for Hospital Indemnity, Cancer, and Accidents, Voluntary Short-Term Disability Insurance, and Voluntary Life and AD&D. 401k and Profit Share: After 90 days, you will be eligible for participation and contribute to our 401(k) plan, administered via Principal. After your first year of employment, Tribeca Pediatrics will make an annual Safe Harbor contribution of 3% of your compensation. Eligible employees will also receive a profit share contribution.