UM Nurse Specialist I

Position summary

Responsible conducting initial medical necessity clinical screening by collecting clinical information to review against evidenced based criteria. This is a full time position and has opportunities to work from home for the right candidate.

Job Requirements

  • Education: Minimum of associates degree required. Active RN license required. License in the state of NY and CA preferred.
  • Experience: 5 years + of clinical experience in hospital or medical office setting

Skills

Excellent triaging skills, basic computer knowledge and typing skills, outstanding clinical knowledge of multiple disease process and how they are diagnosed and maintained, radiology knowledge a plus, communications and phone skills, ability to educate non-clinical staff.

To apply, please email a cover letter, resume and salary requirement to This email address is being protected from spambots. You need JavaScript enabled to view it. with the position being applied for in the subject line. No calls please.

Software Engineer

Position summary

Responsible for internal as well as client facing web applications. The ideal candidate will have several years’ experience developing applications used in a production business environment supporting existing applications as well as creating new applications or class libraries as needed. Designs/codes applications, internal and client facing web applications, following specifications using the appropriate tools. Maintains and modifies existing applications and class libraries on their own as well as under direction from senior staff members. Responsible for performing custom design and enhancements to system applications as necessary and under the direction of senior staff. Assumes responsibility for ongoing data architecture for product.

Job Requirements

  • Education: BS in Computer Science or equivalent on-the-job experience
  • Experience: 2+ years of experience as a developer. Experience with .Net 4 Framework using C#, ASP.Net, ASP.Net MVC and JavaScript, as well as WCF. Understanding of XAML and of Object Orientated Programming and Design Patterns

Skills

  • Ability to effectively communicate technical concepts to other technical staff members.
  • Ability to interface well with Professional Service staff and other non-technical members of the organization.
  • Demonstrated aptitude for learning new technologies.
  • Knowledge relating to the area in which analysis and coding is performed.
To apply, please email a cover letter, resume and salary requirement to This email address is being protected from spambots. You need JavaScript enabled to view it. with the position being applied for in the subject line. No calls please.

Senior Business Analyst

Position summary

Responsible for producing standard and adhoc reporting. A strong emphasis is placed on process documentation and operational compliance. Assist with implementation and management of client reporting needs, meeting the clear target goals for account performance and efficiency, as well as the ability to identify and support the expansion of complimentary reporting capabilities. Assists with analysis of trends, metrics and authorizations/claims oversight for continuous corporate level reporting. Support on-going sales efforts with research and documentation as requested.

Job Requirements

  • Education: Bachelor’s Degree in Business or Health Services Administration, with course work in Business Analytics and/or equivalent of 5 years of work experience.
  • Experience: Prior healthcare experience required (min. 3 years); managed care experience preferred. Experience with reporting tools is required; data warehousing, SharePoint and Client Relationship Management tools in additional to the essential analytical background would be advantageous. A proven track record in process documentation and excellence in analytical oversight is required.

Skills

Excellent organizational, analytical, communication, and presentation skills required. Proficiency with Microsoft Excel including macros and pivot tables, creating and executing SQL queries, stored procedures and functions and experience with SQL Reporting Services, Crystal Reports or an equivalent report designer are required. Experience with SQL Analysis Services and Excel PowerPivot would be advantageous.

To apply, please email a cover letter, resume and salary requirement to This email address is being protected from spambots. You need JavaScript enabled to view it. with the position being applied for in the subject line. No calls please.

Intake Specialist

Position summary

Intake Specialist receives requests for authorization of services via phone calls, faxes, and web submissions, verifies eligibility, inputs medical information, scans and attaches accompanying faxes to case, initiates online authorization based on information received and forwards cases to a Radiology Peer Reviewer. Also, handles inbound calls on follow-up to existing authorization request either in process or processed.

Job Requirements

  • Education: High School Diploma or GED is required.Undergraduate degree preferred.
  • Experience: Minimum of 1 year experience as an Intake Specialist in a multi function call center and/or experience in a medical setting is preferred.
  • Skills: Organizational and excellent communication skills as well as the ability to work under pressure and the ability to multitask are a must.
  • Additional Requirements: Computer literate and willing to learn UM system.

To apply, please email a cover letter, resume and salary requirement to This email address is being protected from spambots. You need JavaScript enabled to view it. with the position being applied for in the subject line. No calls please.

Nurse Auditor

Position summary

Responsible for reviewing/auditing notification letters to MD offices and patients. This is a part time telecommuting position

Job Requirements

  • Education: Must have an active unrestricted NY RN license.
  • Experience: Previous experience in auditing clinical charts preferred. Must have a minimum of 3 years of clinical experience in a hospital or equivalent setting.

Skills

Position requires attention to detail for clinical data and specific requirements for Medicare and Medicaid patients. Excellent writing skills are necessary.

To apply, please email a cover letter, resume and salary requirement to This email address is being protected from spambots. You need JavaScript enabled to view it. with the position being applied for in the subject line. No calls please.