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About the Role
As a Clinical Reviewer (RN), you will complete utilization or quality reviews, supporting Medical Review Analysts and Physician Consultants to ensure an accurate process. You will utilize your knowledge and expertise to conduct clinical level review.
Responsibilities
- Conduct utilization reviews up to and including the appeal level, including chart screening, completing electronic worksheets, entering required information, and making level one denial decisions.
- Conduct quality and clinical study data collection reviews, including chart review and completing detailed electronic data worksheets.
- Act as a resource for administrative staff in training, problem-solving, and clarifying procedures.
- Provide technical assistance and conduct/participate in staff huddles.
- 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.
Skills
- Registered Nurse
- Utilization review
- Quality review
- Clinical study data collection
- Electronic medical records
- Problem-solving
- Collaboration
- Written communication
- Verbal communication
- Independent work
- Flexibility
- Innovation
- Creativity
Location
- Jericho, NY
Work Type
- Office-based
- Full-time
Experience Level
- Minimum of two (2) years’ experience in an acute care facility preferably in medicine/surgery or special care units
- One (1) to three (3) years experience in acute care utilization review
Education Level
- New York State, Licensed Registered Nurse
- 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
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, national origin, disability, protected veteran status or military status, or any other category protected under applicable law.