In the Assistant Director (RN) role, you will serve as clinical support and backup to the Director for all independent external appeals activities. You will assist with management of day-to-day operations of all client products, including administrative denials, medical necessity review, claims reviews, and DRG review. The Assistant Director (RN) will provide training and development for review activities to internal staff. Duties include but are not limited to:

With Director supervision, responsible for overseeing and tracking compliance with various health care rules, jurisdictional laws/regulations, and contract requirements. Audits compliance and responds to any detected risks or problems and, with Director input, determines appropriate action to prevent any recurrence of issues.
Direct supervisory staff including clinical, nurses, coders, and support staff performing review activities. Participate in negotiations with providers, as necessary. Respond to clinical and procedural questions and coordinate any revisions of Departmental processes and procedures.
Assist in oversight of operations, including report production. Manage the implementation of technical changes to review programs based on client needs and regulatory changes.
Responsible for maintaining the network of nurse and physician reviewers. Monitor timing and savings, as well as oversee the quality of the product(s).
Train staff and monitor their performance.
Provide backup and coverage for the Director with Assistant VP assistance.
Assist with new product development, marketing, and business development.
Must be available for out of hours coverage and staff supervision for planned peak review times.

This position is office based at our Jericho, NY office.

Qualifications:

Excellent interpersonal skills.
Highly organized with strong time management skills.
Excellent communication skills (written and verbal) with the proven ability to successfully direct both professional and support staff and work with governmental agencies, providers and clients.
Excellent supervisory/management skills with the ability to set work schedules, identify problems and formulate solutions.
Familiarity with computer system support to assure client satisfaction.
Familiarity with data/management information systems with the capability of understanding and interpreting contract language and governmental regulations.

Education & Experience:

New York Licensed Registered Nurse and a graduate of an approved registered, professional nurses' training program, required.
A bachelor's degree in nursing or related discipline, required.
Five (5) years of health care experience with at least three (3) years in health care review, 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 $80,000.00 - $115,000.00. 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 Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status.

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Assistant Director