RN Clinical Reviewer – IDR
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Job Description
Registered Nurse Clinical Reviewer responsible for conducting comprehensive medical-legal reviews remotely for a non-profit organization. Collaborating with administrative and clinical teams to ensure compliance and accurate determination.
Responsibilities:
- Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations.
- Act as a resource for the administrative and clinical staff in training, problem-solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles.
- Participate in collaborative training
- Other activities as may be deemed necessary
Requirements:
- Education: Baccalaureate degree in Nursing or a graduate of an approved RN program.
- Licensure: Current New York State RN license
- Experience:
- Must have at least 3 years of experience in a Med-Legal review setting.
- Must have 1-3 years of experience in acute care utilization review/ appeals background.
- Technical Skills: Experience with electronic medical records; strong research capabilities
- Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills
Benefits:
- Competitive Compensation: $50/hr.
- Comprehensive Benefits:
- 1 Week of Paid Vacation based on accruals after 3 months of employment (2 weeks of Paid Vacation with accrual starting your second year of employment)
- 6 Major Paid Holidays per year (after 3 months of employment)
- 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act
- License Reimbursement after 1 year of employment
- Health insurance is subject to plan eligibility requirements
- 401(k) Matching eligibility after 1 year of employment
- Benefits from Paychex, such as Payactiv
- GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.
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