Registered Nurse Clinical Reviewer

About the Job

Registered Nurse Clinical Reviewer / IDR - Jericho, NY (#25154D)

Location: Jericho, NY.

Employment Type: Full-time.

Hourly Rate: $60/hr (based on experience).

Position Overview:

We are currently seeking a Registered Nurse Clinical Reviewer / IDR to fill an opening with a Non-profit organization located in Jericho, New York. This role is ideal for an experienced RN with a utilization review or appeals background who thrives in a collaborative, independent, and deadline-driven environment.

Why Join Us?

• Competitive Compensation: Earn a competitive rate of $60 per hour based on experience.
• 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.
• Work Schedule: Full-time position.
• Professional Growth: Gain valuable experience in independent dispute resolution (IDR), medical-legal review, and appeals within a supportive non-profit setting.
• Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through fair, evidence-based clinical determinations.

Qualifications:

• Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program.
• Licensure: Must be licensed as a Registered Professional Nurse in New York State.
• Experience:
  • 1-3 years of experience in utilization review and/or appeals background required.
  • Must have at least 3 years of experience in Med-Legal review setting.
• Technical Skills: Knowledge and experience with electronic medical records (EMR).
• Soft Skills:
  • Ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
  • Excellent written and verbal communication skills.
  • Ability to work independently with little supervision.
  • Ability and desire to be flexible, innovative, and creative.
  • Ability to meet deadlines in a time-sensitive environment.

Key Responsibilities:

• Conduct reviews up to and including the appeal level. This includes chart screens, 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.

About the Company

We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming.At Greenlife our mission is to make this process easier for you and help you through all the steps necessary to find that perfect new position or the healthcare professional to round out your team.We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.