Based in Albany, working at the direction of the NYS Department of Health (DOH), you will be primarily responsible for the day-to-day case management of Nursing Facility Quality of Care Complaints. As a Nursing Facility Resolution Reviewer, you will interface with the resident and/or resident’s representative throughout the complaint resolution process including assisting with alternative dispute resolution; communication with the nursing facility; case processing including preparation of correspondence and assistance with mediation; medical record review and related activities to assure compliance with timelines and confidentiality regulations. You will also participate in other resident protection activities as directed.
QUALIFICATIONS:
- Strong interpersonal skills are desirable to facilitate positive customer satisfaction in situations that are adverse or in controversy.
- Excellent communication (verbal and written) skills.
- Ability to work independently with minimal supervision.
- Ability to relate effectively to providers, physicians, senior medical and administrative personnel, and residents/patients.
- Strong computer skills with the ability to learn new programs.
- The ability to obtain Surveyor Minimum Qualifications Test (SMQT) certification within 12 months of employment, required.
- Able to travel to on-site facility review assignments.
EDUCATION & EXPERIENCE:
- NYS Licensed RN, required.
- Graduate of an approved, registered professional nursing program, required. A bachelor’s degree in nursing, preferred.
- Two (2) years’ experience performing utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities; OR
- Three years of clinical or administrative experience, required.
- SMQT Certification, preferred.
The salary range for this position is $31.00 - $35.00/hr. Actual salary depends on a variety of factors including experience, education, credentials, location, and budget.
IPRO is an Affirmative Action/Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity or expression, disability, protected veteran status, or military status.
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