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Registered Nurse 2 - Medical Care (NY HELPS)

New York StateNassau

Vor 30+ Tagen

Stellenbeschreibung

Minimum Qualifications Candidates must possess a current license and registration as a registered professional nurse in New York State AND

two years of registered nursing experience in the following areas : rehabilitation, medical / surgical, public health, community health, visiting nursing, occupational health, utilization review, or review of medical records from hospitals for appropriate ICD 9 or 10 / DRG / PAS / CPT coding.
A bachelor’s degree in nursing can substitute for one year of post-licensure clinical nursing experience. A master’s degree in nursing can substitute for two years of post-licensure clinical nursing experience.

Duties Description Reporting to a Registered Nurse supervisor, Registered Nurse 2 (Medical Care) positions at NYSIF are responsible for coordinating global case management of high-cost complex cases and are an extensive resource / mentor of the NYS Workers’ Compensation Board Medical Treatment Guidelines for Claims Service Managers and other Claims staff. Each Registered Nurse 2 will be assigned to one of the following focused teams : claimant outreach / accelerated care plan catastrophic and / or high-cost claims team, prior authorization team, or claims management and consulting team. Duties will include, but not be limited to :

Identify and manage high medical exposure claims for NYSIF.

Early intervention of medically complex claims to decrease exposure and provide increased customer satisfaction.

Contact claimants and potentially providers, facilities, families, employers, etc. based on the claimant's medical status.

Evaluate and authorize or deny prior authorizations for medications and durable medical equipment.

Serve as a resource to claims staff in providing effective medical knowledge and management of these claims.