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About the Role
Responsible for the review and processing of requests for Independent Reviews from External Agencies in accordance with contractual guidelines. This involves communicating with contractors, providers, and beneficiaries upon receipt of medical records, performing case reviews using regulatory guidelines and clinical knowledge, and preparing written correspondence.
Responsibilities
- Review and process requests for Independent Reviews from External Agencies.
- Communicate with contractors, providers, and beneficiaries/representatives upon receipt of electronic medical records.
- Perform case reviews utilizing regulatory guidelines criteria and clinical knowledge for medical necessity and quality of care issues.
- Formulate a case summary and review questions for the Physician Reviewer.
- Review physician determinations, ensuring all categories of concern have been addressed.
- Prepare written correspondences to contractors, providers, and beneficiaries/representatives.
Requirements
- Ability to interact with providers, internal/external customers and representatives.
- Excellent communication skills (both verbal and writing) with a professional demeanor.
- Ability to work independently, as well as in a team environment.
- Excellent time management/prioritization skills to meet contractual deadlines while maintaining a high level of quality work.
- Strong clinical critical thinking skills.
- Advanced skills and knowledge of standard EHR applications, office technology and Microsoft applications including Word, Excel, and PowerPoint.
- Ability to handle sensitive and confidential information.
Skills
- EHR applications
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
Location
- Jericho, NY
Work Type
- Full-time
- Hybrid
Experience Level
- Minimum of three (3) years clinical experience in an acute care setting or related experience
- Experience in utilization and quality reviews
- Experience in managed care, quality management and peer review (preferred)
Education Level
- Licensed Registered Nurse (any state license accepted)
- Graduate of a School of Nursing
- Bachelor of Science in Nursing (BSN)
Salary/Compensations
- $38.46 – $43.27 per hour
About the Company
- IPRO is an Equal Opportunity Employer.
Equal Opportunity
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, protected veteran status or military status, or any other category protected under applicable law.