Utilization Review Nurse (MLTC)(Fully Remote) Job at Medix, New York, NY

ZTVFMUNsTWNLcmNSNkphRXhhUnpzcXpMVUE9PQ==
  • Medix
  • New York, NY

Job Description

We are hiring a Fully Remote UM Nurse for a Health plan based out of New York! MLTC Plan experience is required.

This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services!

Requirements: NY RN license (UM experience is required, MLTC experience required)

Hours : Monday - Friday 9am-5pm or 8am-4pm (Full time hours only)

Location: Remote (based out of NY)

Pay: $45-50/hr

Job Details:

Some of your daily activities will include:
  • Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria - prospective, concurrent and retrospective review.
  • Frequently collaborates and communicates with physician peer reviewers and medical directors in determining coverage of requested services.
  • Provide intervention and coordination to decrease delays and denials.
  • Maintains timely, complete and accurate documentation in compliance with VCMAX policies and procedures.
  • Support Quality and Performance Improvement Initiatives.
  • Timely follow-up on results of denial and internal appeal

#Medix #MedixNE

Job Tags

Full time, Monday to Friday,

Similar Jobs

Blitt and Gaines, P.C.

Placement Representative Job at Blitt and Gaines, P.C.

 ...development of new skillsets. This role is a data entry level role that allows you to learn new skills...  ...as up front account maintenance and coding Tracking all files up until merging...  ...Gaines, P.C. offers PTO, Paid Holidays, Medical Benefits, Competitive Salary and 401k... 

Tech Associates Inc

Junior Network Engineer Job at Tech Associates Inc

C2C or W2Tech Associates is currently seeking a Junior Network Engineer with our clients in NYC, NJ, and CT. This is a 12 + month contract position.Minimum Skills and Experience:Excellent understanding of network architectures including the roles of routers, switches... 

HSN

On-call Creative Product Photographer Job at HSN

US13149 The Opportunity The Creative Product Photographer is responsible for producing Creative Brand quality product images for items on all of HSN Platforms. The Creative Product Photographer adheres to established elevated standards and shooting techniques to... 

Croplife America

Government Relations Coordinator and CLPAC Manager Job at Croplife America

 ...time Description CropLife America (CLA), a trade association located in the Washington, DC area, is seeking a full-time Government Relations Coordinator and CLPAC Manager. The Government Relations Coordinator and CLPAC Manager is a member of the Government... 

Buckeye Elementary School District

24-25 Bus Monitor Job at Buckeye Elementary School District

 ...TITLE Bus Monitor 2. JOB GOAL To assist the Self Contained Special Education Teacher with the implementation of the Individual Education...  ...program. ~ QUALIFICATIONS # Experience working with school- aged children. # Experience working with children with...