VillageCare
RN Appeals Nurse
VillageCare is looking for a self‑motivated and passionate RN for our Appeals Nurse position. While supporting the Utilization Management team, the Appeals Nurse will conduct comprehensive analytic reviews of clinical documentation, use clinical knowledge to make authorization decisions, and assist with appeal determinations. Responsibilities
Collect information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation necessary to reach prospective, concurrent, and retrospective decisions in the appeals process. Review and interpret a variety of instructions and medical notes furnished in written and oral form to determine appropriate action toward appeal. Write sound, factual, clinical arguments and attend Administrative Law Judge hearings for warranted appeals. Detect problems, recognize important information, and link various data to support decision‑making. Qualifications
Current unrestricted NYS RN license. Bachelor of Science in Nursing (BSN); Master’s degree preferred. 5+ years of practical experience in a healthcare setting. 3+ years of quality management experience. Prior experience analyzing data and knowledge of CMS/DOH regulatory requirements. Must reside in the NY tri‑state area (NY, NJ, or CT). Benefits
PTO package 10 Paid Holidays Personal and Sick time Medical/Dental/Vision coverage HRA/FSA Education Reimbursement 403(b) Retirement Savings Life & Disability insurance Commuter Benefits Paid Family Leave Additional Employee Discounts Salary: $87,647 – $98,603 per year Location: 112 Charles Street, New York, NY 10014 VillageCare is an Equal Opportunity Employer.
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VillageCare is looking for a self‑motivated and passionate RN for our Appeals Nurse position. While supporting the Utilization Management team, the Appeals Nurse will conduct comprehensive analytic reviews of clinical documentation, use clinical knowledge to make authorization decisions, and assist with appeal determinations. Responsibilities
Collect information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation necessary to reach prospective, concurrent, and retrospective decisions in the appeals process. Review and interpret a variety of instructions and medical notes furnished in written and oral form to determine appropriate action toward appeal. Write sound, factual, clinical arguments and attend Administrative Law Judge hearings for warranted appeals. Detect problems, recognize important information, and link various data to support decision‑making. Qualifications
Current unrestricted NYS RN license. Bachelor of Science in Nursing (BSN); Master’s degree preferred. 5+ years of practical experience in a healthcare setting. 3+ years of quality management experience. Prior experience analyzing data and knowledge of CMS/DOH regulatory requirements. Must reside in the NY tri‑state area (NY, NJ, or CT). Benefits
PTO package 10 Paid Holidays Personal and Sick time Medical/Dental/Vision coverage HRA/FSA Education Reimbursement 403(b) Retirement Savings Life & Disability insurance Commuter Benefits Paid Family Leave Additional Employee Discounts Salary: $87,647 – $98,603 per year Location: 112 Charles Street, New York, NY 10014 VillageCare is an Equal Opportunity Employer.
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