Nursing Facility Resolution Reviewer (RN req'd)

Strong interpersonal skills are desirable to facilitate positive customer satisfaction in situations that are adverse or in controversy. Ability to work independently with minimal supervision, as well as in a team environment. Excellent written and verbal skills with the ability to communicate professionally with co-workers, supervisors, providers, medical and administrative personnel, and residents/patients. Strong computer skills with working knowledge of Microsoft Office products and the ability to learn new programs. Ability to translate collected information into a clear, concise, legal, and defensible document. If approved to work remotely, must have secure internet that meets the speed required to perform all work duties, must have workspace that provides privacy for all work-related calls, and must be able to secure all work-related items when not in use. The ability to obtain Surveyor Minimum Qualifications Test (SMQT) certification within 12 months of employment, required. Must have a valid driver’s license & the ability to travel, required. EDUCATION & EXPERIENCE: NYS Licensed, Registered Nurse, required. A minimum of two (2) years of experience in performing utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, OR three (3) years of clinical or administrative experience, OR a bachelor’s degree in nursing and two (2) years of clinical or administrative experience. SMQT certification, preferred.

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