Job DetailsTired of the backaches, long hours and stressful shifts? Use your brain and not your back, uncovering unnecessary treatment and waste in healthcare. If you are a seasoned bedside warrior with extensive Medical Surgical experience and are looking to step away from bedside, and into a unique office setting in Manhattan, this is for you.As a detective ( cost outlier auditor), you'll work with hospitals and insurance companies to uncover the truth. Your solid medical surgical nursing experience is the foundation of a successful detective. You'll be fully trained and provided all the tools needed to enrich your career.For nearly five decades, this forward thinking organization has been a mainstay here in NYC as a leader in medical review. They have been leading the charge in providing health care assessment services that assist clients in improving the appropriateness, quality and cost effectiveness of health care. This is a group with an outstanding reputation for delivering top notch medical review programs for prospective, concurrent and retrospective monitoring, thus helping to eliminate the "waste" in healthcare. The external reputation is only surpassed by the incredible internal company culture. This is a place where many come to learn, grow and enjoy an entire happy career.Why You Should be Interested:Ability to leave bedside and work in a professional, fun office environment.Be a part of a dynamic team of talented nurses who share a passion for investigating.Comprehensive training and tools and ongoing learning to help fuel your success.Ditch the 12 hour shifts/ weekends and holidays and join us Monday-FridayComprehensive Health Care BenefitsSalary $80,000 to start.TransitCheckGreat PTO PlanRetirement Savings PlanFun company events and regular employee recognition.The Role You Will PlayDetermine if the patient’s level of care is appropriateDetermine if the patient could have been monitored at a lower level careDetermine if all the items billed by the hospitals were ordered by the physicianLook for the physician’s order for all items billed by the hospitalInvestigate and evaluate medical record documentationPerform various reviews such as Cost Outliers, Day Outliers, Pre and Post Payment utilization review.Perform QA Reviews as assigned.Assists the Operations department with data abstraction for special studiesFind documentation that indicates if the RN administered the medicationRefer cases to the physiciansNo more foot massages neededIdeal Background ProfileBSN or Equivalent3+ Years of recent medical surgical nursingDesire to work in a professional office setting away from bedside nursing.Ability to work daily in Manhattan.
