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:

• 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

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