Clinical Reviewer (RN)

ISLAND PEER REVIEW ORGANIZATION INC • Jericho, NY

5h • $38 - $43 • Onsite

About The Position

As a Clinical Reviewer (RN), you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You will utilize your knowledge and expertise of the review program to conduct clinical level review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process. This position is office based at our Jericho, NY office.

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.
• New York State, Licensed Registered Nurse, required.
• 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.
• Minimum of two (2) years’ experience in an acute care facility preferably in medicine/surgery or special care units; AND/OR one (1) to three (3) years experience in acute care utilization review.

Responsibilities

• Conduct utilization reviews up to and including the appeal level. This includes chart screen, complete electronic worksheets, enter required information and make level one denial decisions when necessary.
• Conduct quality and clinical study data collection reviews. This includes chart review, complete detailed electronic data worksheets.
• Act as a resource for the administrative staff in training, problem solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles.
• Participate in collaborative training specific to clinical study objectives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level