Clinical Reviewer (RN)

ISLAND PEER REVIEW ORGANIZATION INC • Jericho, NY

4d • $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 for Rhode Island. 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 setting preferably in medicine/surgery or special care areas.
• In addition, candidates should also possess one (1) to three (3) years experience in acute care utilization review, including extensive experience with prior authorization process.

Nice To Haves

• Rhode Island Licensed Registered Nurse, preferred or willing to obtain Rhode Island licensure upon onboarding.

Responsibilities

• Conduct utilization reviews up to and including the appeal level. This includes 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. This includes collaboration of annual psychiatric reports and long-term mental health reviews.
• Act as a resource for the administrative staff in training, problem solving, and clarifying procedures.
• Participate in collaborative training specific to clinical study objectives.

Benefits

• IPRO is an Equal Opportunity Employer. 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree