Complaint Intake and Triage Nurse Reviewer

This is a fully remote position, open to applicants in New York.

📋 Description

• Conduct clinical evaluations and assess complaints and incident reports for potential noncompliance, received through telephone, electronic, postal mail, or other channels.

• Execute reviews regardless of the submission method.

• Classify complaints by severity in accordance with federal triage guidelines.

• Carry out data entry and determine the appropriate actions aligned with federal triage protocols.

• Perform comprehensive assessments of complaints to establish the right course of action.

• Accurately document findings in a timely manner.

• Collaborate with team members and other stakeholders as necessary to ensure effective resolution of complaints.

• Engage in training and professional development activities as required.

• Comply with NYSDOH policies, procedures, and work schedules.

• Undertake other activities as deemed necessary.

⛳️ Requirements

• Strong interpersonal abilities.

• Exceptional verbal and written communication skills.

• Capability to work independently with minimal supervision.

• Ability to effectively engage with providers, physicians, senior medical and administrative personnel, as well as residents/patients.

• Basic computer skills, including a working knowledge of all Microsoft Office applications.

• Ability to obtain the Surveyor Minimum Qualification Test Certification within 12 months of employment.

• Travel may be necessary to meet training requirements.

• Must possess a valid driver's license.

• Must be a resident of New York State.

• New York State Registered Professional Nurse (RN) is required.

• A minimum of two (2) years’ experience in utilization review, medical review, fraud investigations, surveillance, or monitoring activities at the facility level.

• A minimum of three (3) years of clinical experience in a medical facility, preferably in a nursing home setting.

🏝️ Benefits

• 5 Sick Days (40 Hours) subject to the provisions of the NYS Paid Sick Leave Act.

• Health insurance is dependent on plan eligibility requirements.

• Gain valuable experience in complaint triage, clinical review, and regulatory compliance with the NYS Department of Health.

• Contribute to a mission-driven organization committed to enhancing patient outcomes by identifying potential noncompliance and ensuring the safety and well-being of nursing home residents.