AdvantageCare Physicians (ACPNY)

  • Clinical Reviewer (Registered Nurse)

    ID
    2018-5114
    Office Name
    55 Water St.
    Type
    Full Time
    City
    New York
    Union / Non-Union
    Non-Union
    Primary Location
    US-New York
    Daily Schedule
    Monday-Friday 8am-5pm
    Dept/Spec
    Clinical Care_Quality [71017]
  • Overview

    Having the best Clinical Reviewer at AdvantageCare Physicians enables us to achieve our vision to be the preferred care destination for our patients and the communities we serve. At AdvantageCare Physicians, our mission is to focus care on the needs of our patients and partner with them in the pursuit of better health.

     

    AdvantageCare Physicians (ACPNY) is one of the largest physician-led multi-specialty practice in the New York metropolitan area, serving half a million patients across Manhattan, Brooklyn, Queens, Staten Island and Long Island. At ACPNY, patients receive individualized coordinated care from a compassionate team focused on helping them live their healthiest lives.

     

    Our 30+ professionally managed, multi-specialty physician practices are designed to deliver convenient, comprehensive and community-based care. At AdvantageCare Physicians primary and specialty care is coordinated through an integrated network of full-service medical offices, regional specialty referral hubs, urgent care centers and strategic hospital affiliations across Manhattan, Brooklyn, Queens, Staten Island and Long Island.

     

    The Clinical Reviewer is responsible for coordinating authorizations, notifications, denials and pre-certifications. In this role, they will conduct medical chart audits to assess utilization review outcomes, medical necessity/level of care, physician orders and level of care to complete requirements for authorizations.

    Responsibilities

    • Serve as the clinical liaison for the practice, physician, and all revenue cycle teams and be a vital part of assisting patients to be financially cleared/authorized for procedures.
    • Evaluate clinical documentation and communicate clinical necessity  to insurance companies or third party vendors via telephone and or electronically.
    • Educate providers on Utilization and Medical Management guidelines and processes.
    • Provide clinical knowledge and act as clinical resource to the non-clinical team.
    • Enter clinical information in various medical management systems including but limiting Epic and Evicore.

    Qualifications

    Education & License:

     

    • Graduate of an accredited school of nursing
    • Bachelor's Degree in Nursing (P)
    • Current, unrestricted, New York State Registered Nurse license (RN)

     

    Work Experience & Skills:

     

    • Minimum 3 years' nursing experience
    • Proficiency in Excel and Word
    • Ability to organize and set priorities to complete workload in a timely and efficient manner
    • Ability to maintain cooperative and effective interpersonal relationships with insurance companies, medical staff and patients
    • Must be able to work within a team environment that requires consistent accurate and precise communication among team members
    • Epic knowledge and experience a plus

    • Case Management experience (P)
    • Clinical review experience (P)
    • Knowledge of ICD-10 Coding (P)

     

     

     

     

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