Grievance & Appeals Quality Reviewer 9/13/2016
Visiting Nurse Service Of New York
JOB DESCRIPTIONAPPLY OVERVIEW:
Visiting Nurse Service of New York (VNSNY) is the nation s largest not-for-profit community-based health system. VNSNY provides a comprehensive array of home- and community-based programs, including health plans, tailored to the needs of high-risk, vulnerable New Yorkers, improving their quality of life. Each day, more than 18,000 VNSNY employees including nurses, rehabilitation therapists, social workers, dieticians, other allied professionals, and paraprofessionals deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 35,000 patients, helping them to live the best lives possible.
RESPONSIBILITIES AND QUALIFICATIONS:
Identifies and resolves operational quality problems and inefficiencies within the Grievance & Appeals (G&A) department. Conducts daily reviews of G&A case files, letters, and database records against required criteria. Ensures compliance with CHOICE policies and procedures, regulatory requirements and business practices. Prepares summary reports and provides recommendations to reduce errors and improve process performance. Works under general supervision.
Education: Bachelor&rsquot;s degree in health care administration, human services or business administration or related discipline or the equivalent work experience in a related professional field required.
Experience: Minimum four years professional experience in health care, including a minimum of two years in grievance and appeals in a Managed Care setting, required. Excellent verbal/written communication skills required. Proficient computer and typing skills, and knowledge of Microsoft Office (Word and Excel) and database software required. Demonstrated ability to work in a fast paced environment and effectively manage multiple grievances and appeals simultaneously required. Experience in one or more of the following areas: Audits, Compliance, and Medicare/Medicaid reporting required. Excellent verbal and written, presentation, communication, and writing skills required. Demonstrated ability to work effectively with employees at all levels of the organization required.
VNSNY is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights, then please visit: