Remote UM & Grievance Appeals RN (NY Licensed)

Phaxis; New York (NY); Remote; USD 72.000 - 77.000; Teilzeit

Benefits dieser Stelle

100% remote

Zusammenfassung

Phaxis is hiring a Remote UM / Grievance & Appeals RN (NY License) for a contract role with a New York health plan. If you have owned appeals from intake to final decision letter, we want to talk to you.

You will review medical necessity for outpatient and community-based services, draft determination letters, and prepare cases for Fair Hearings and CMS external reviews. A NY RN license and payer-side experience are required.

Qualifikationen

• Active, unrestricted New York RN license.
• 2+ years of payer-side grievance and appeals experience.
• UM or case management experience (InterQual/MCG).
• Outpatient, home health or LTC experience; not inpatient-only.
• Knowledge of CMS and NY Medicaid/MLTC appeals rules.

Aufgaben

• Review medical necessity for outpatient and community-based services.
• Write determination letters and related documentation.
• Prepare cases for Fair Hearings and CMS external reviews.

Kenntnisse

RN license

Payer-side appeals

Utilization management

InterQual/MCG

Outpatient/Home health/LTC

CMS NY Medicaid/MLTC rules

Tools

InterQual/MCG

Jobbeschreibung

Phaxis is hiring a Remote UM / Grievance & Appeals RN (NY License) for a contract role with a New York health plan. If you have owned appeals from intake to final decision letter, we want to talk to you.

You will review medical necessity for outpatient and community-based services, draft determination letters, and prepare cases for Fair Hearings and CMS external reviews. A NY RN license and payer-side experience are required.