Job Description

Job Description

Job Description

Based in Albany, in this role you will be primarily responsible for the day-to-day case management of nursing facility quality of care complaints working at the direction of the New York State Department of Health (DOH). 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 activities, including other resident protection activities, as directed.

Potential opportunity to telecommute will be considered.

QUALIFICATIONS:

• Strong interpersonal skills are desirable to facilitate positive customer satisfaction in situations that are adverse or in controversy.
• Ability to 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.
• Strong computer skills with working knowledge of Microsoft Office products and the ability to learn new programs.
• Ability to translate collected information into a clear, concise, legal, and defensible document.
• 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.
• The ability to obtain Surveyor Minimum Qualifications Test (SMQT) certification within 12 months of employment, required.
• Must have a valid driver’s license & the ability to travel, required.

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.
• SMQT certification, preferred.

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 hourly range for this position is $35.90 – $36.92. 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.

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