Program Review Associate - LPN

This individual is primarily responsible for the review and coordination of Medicare fee-for-service (FFS) and Medicare Advantage (MA) appeals of denials of Medicare coverage, as well as hospital discharge appeals, including alternating weekend and holiday coverage. Must have the ability to work independently with little supervision. Effective written and oral communication skills with Medicare beneficiaries and/or their representatives, physicians, providers, administrative and medical personnel. Understands and uses required peer review monitoring tools. May also participate in Helpline support as directed.

QUALIFICATIONS:

  1. Ability to relate effectively with medical and administrative personnel as well as the public.
  2. Must be flexible and willing to work a rotating schedule that includes alternating weekends and holidays.
  3. Ability to work independently.
  4. Excellent writing skills.

EDUCATION & EXPERIENCE:

  1. Graduate of an approved Licensed Professional Nurse training program and licensed to practice in the State of New York.
  2. A minimum of three (3) years of experience in acute care medicine /surgery, discharge planning, or Nursing Facility or Homecare or CORF or Hospice settings.
  3. Satisfactory equivalent combination of both education and experience with proven ability to fulfill duties.

Please submit resume with cover letter and salary requirements to:

IPRO

Attn: Human Resources

1979 Marcus Avenue

Lake Success, NY 11042

Fax: 516 328-1551

PH: 516 209-5621

fdirector@ipro.org

For questions about this position, please visit our bulletin board.

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