Grievance & Appeals RN Specialist - Clinical

VNS Health; New York (NY); On-site; USD 93,000 - 117,000; Full time

Job summary

VNS Health in New York seeks a registered nurse to resolve grievances, appeals and external reviews for MLTC/MA/select Health products. You will ensure regulatory compliance and timeliness, maintain records, and communicate outcomes to enrollees and providers.

The role requires NY RN license, Bachelor's or Master's in Nursing preferred, and at least three years in healthcare including two in grievance or related areas.

Qualifications

• Licensed and current NYS RN license
• Bachelor's or Master's in Nursing preferred
• Three years of progressive health-care experience, including two years in grievance/appeals or related area
• Proficient verbal/written communication and strong computer skills
• Ability to work in a fast-paced environment and manage multiple grievances and appeals

Responsibilities

• Resolves grievances, appeals and external reviews for specified VNS Health Plans
• Ensures regulatory compliance and timeliness in processing
• Maintains accurate records documenting actions and rationale
• Develops correspondence communicating outcomes to enrollees/providers
• Assists with data collection and reporting
• Coordinates with Claims, Medical Management and third-party staff as needed

Skills

Verbal & written communication

MS Office proficiency

Typing speed

Case management

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

Microsoft Office

Job description

VNS Health in New York seeks a registered nurse to resolve grievances, appeals and external reviews for MLTC/MA/select Health products. You will ensure regulatory compliance and timeliness, maintain records, and communicate outcomes to enrollees and providers.

The role requires NY RN license, Bachelor's or Master's in Nursing preferred, and at least three years in healthcare including two in grievance or related areas.