As the Legal Nurse you will complete the full spectrum of activities related to State and Federal Independent Dispute Resolution (IDR) case determinations. Conducting clinical level review, prior authorization, and disputed benefits review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process. Duties include but are not limited to:

• Conduct reviews up to and including the appeal level.  Involving chart screen, compiling regulatory guidance, researching insurer requirements, complete electronic worksheets and preparing final determinations. 
• Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations.
• Provide technical assistance and conduct/participate in staff hurdles.
• Participate in collaborative training.

Potential opportunity for Hybrid option (3 days in office 2 days home) considered after initial orientation/training period.

QUALIFICATIONS:

• Knowledge and experience with electronic medical records.
• Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal skills.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative.
• Ability to meet deadlines in time sensitive environment.

 EDUCATION & EXPERIENCE:

• New York Licensed Registered Nurse, required.
• A bachelor’s degree in nursing or graduate of an approved Registered Professional Nurses training program, required.
• Legal Nurse Consultant Certification, required.
• Three (3) years’ experience in Med-Legal review setting, required.

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $87,000.00 – $93,600.00. Actual salary range and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range and/or hourly rate listed does not include other forms of compensation or benefits. 

IPRO is an Affirmative Action/Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.