Impress employers and recruiters.
Choose from hundreds of resume examples.
Impress employers and recruiters.
Choose from hundreds of resume examples.
Target Resume Now
About the Role
As a Clinical Reviewer (RN), you will complete utilization or quality reviews, utilizing your expertise to support Medical Review Analysts and Physician Consultants in ensuring an accurate process for Rhode Island.
Responsibilities
- Conduct utilization reviews up to and including the appeal level, including admission screening of medical, surgical, rehabilitation and psychiatric charts.
- Process authorizations, discharges, and waivers.
- Conduct concurrent and retrospective reviews.
- Conduct quality and clinical study data collection reviews, including collaboration of annual psychiatric reports and long-term mental health reviews.
- Act as a resource for administrative staff in training, problem solving, and clarifying procedures.
- Participate in collaborative training specific to clinical study objectives.
Requirements
- Knowledge and experience with electronic medical records including utilization, quality, and clinical charting.
- Ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
- Excellent written and verbal skills.
- Ability to work independently with little supervision.
- Ability and desire to be flexible, innovative, and creative.
Location
- Jericho, NY
Work Type
- Office-based
Experience Level
- Minimum of two (2) years’ experience in an acute care setting preferably in medicine/surgery or special care areas.
- One (1) to three (3) years experience in acute care utilization review, including extensive experience with prior authorization process.
Education Level
- New York State, Licensed Registered Nurse required.
- Rhode Island Licensed Registered Nurse, preferred or willing to obtain Rhode Island licensure upon onboarding.
- A bachelor’s degree in Nursing OR graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York, required.
Salary/Compensations
- $38.46 - $43.27 hourly
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, national origin, disability, protected veteran status or military status, or any other category protected under applicable law.