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Weekday Insurance Utilization Review Jobs in New York

GQR Global Markets

RN Case Manager

Bronx, NY · On-site

$3.0K - $3.1K/wk

Case Management/Utilization Review Shift: Day Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed for each assignment

GQR Global Markets

RN Case Manager

Mount Vernon, NY · On-site

$2.8K - $2.9K/wk

Case Management/Utilization Review Shift: Day Shift Details: null Day Job Type: Travel Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for new ...

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All JobsWeekday Insurance Utilization Review JobsWeekday Insurance Utilization Review Jobs in New York

Weekday Insurance Utilization Review information

What is the difference between Weekday Insurance Utilization Review vs Weekday Claims Processor?

AspectWeekday Insurance Utilization ReviewWeekday Claims Processor
Primary RoleAssessing medical necessity and appropriateness of servicesProcessing and reviewing insurance claims for payment
CredentialsOften requires healthcare or insurance certificationsTypically requires insurance or administrative experience
Work EnvironmentHealthcare settings, insurance companiesInsurance companies, healthcare offices
FocusMedical review and authorizationClaims data entry and verification

Weekday Insurance Utilization Review focuses on evaluating medical necessity, while Weekday Claims Processors handle the administrative processing of insurance claims. Both roles are essential in the insurance industry but serve different functions related to claims management and healthcare authorization.

What are the most commonly searched types of Insurance Utilization Review jobs in New York?

The most popular types of Insurance Utilization Review jobs in New York are:

What cities in New York are hiring for Weekday Insurance Utilization Review jobs?

Cities in New York with the most Weekday Insurance Utilization Review job openings:

Weekday Insurance Utilization Review jobs near you

Clinical Reviewer (Proofer)

Greenlife Healthcare Staffing

Jericho, NY • On-site

$45/hr

Full-time

Medical

Posted 8 days ago

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

Benefits

  • 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.
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About Greenlife Healthcare Staffing

Sourced by ZipRecruiter

Greenlife Healthcare Staffing is a nationwide recruitment agency, matching both new grads and advanced practitioners to hospitals, clinics, nursing homes, multi-specialty groups, and private practices.

Industry

Recruiting and staffing services

Company size

11 - 50 Employees

Headquarters location

New York, NY, US

Social media

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