Registered Nurse Clinical Reviewer / AIMS - Remote
About The Position
Greenlife Healthcare Staffing is seeking a Registered Nurse Clinical Reviewer / AIMS for a remote position with a nonprofit organization in New York. The role is suited to an experienced RN with acute-care utilization review experience who is detail-oriented, flexible, and able to work independently. The reviewer completes utilization or quality reviews as assigned, applying knowledge of the review program to conduct clinical-level reviews and support Medical Review Analysts and Physician Consultants in maintaining an appropriate and accurate process. The position is full-time, Monday through Friday, with remote work flexibility, and pays $50 per hour. It offers experience in utilization review, quality improvement, and clinical study data collection in a supportive, mission-driven nonprofit environment.
Requirements
- Baccalaureate degree in Nursing or graduation from an approved Registered Professional Nurses training program.
- Current licensure as a Registered Professional Nurse in New York State.
- At least two years of experience in an acute-care facility, preferably in medicine/surgery or special-care units, and/or one to three years of experience in acute-care utilization review.
- Knowledge of and experience with electronic medical records, including utilization, quality, and clinical charting.
- Experience with InterQual and Milliman (MCG) criteria.
- Proficiency in completing electronic worksheets and data entry.
- Ability to oversee, problem-solve, and collaborate with peers and medical, analytical, and administrative support staff.
- Excellent written and verbal communication skills.
- Ability to work independently with little supervision.
- Flexibility, innovation, and creativity.
- Strong attention to detail and ability to meet deadlines in a time-sensitive environment.
Responsibilities
- Complete the full range of utilization or quality review activities as assigned.
- Conduct utilization reviews through the appeal level, including chart screening, completing electronic worksheets, entering required information, and making level-one denial decisions when necessary.
- Conduct quality and clinical study data-collection reviews, including chart review and completion of detailed electronic data worksheets.
- Support Medical Review Analysts and Physician Consultants in carrying out appropriate and accurate review processes.
- Serve as a resource for administrative staff by providing training, problem-solving assistance, procedural clarification, and technical support; conduct or participate in staff huddles.
- Participate in collaborative training related to clinical study objectives.
- Perform other activities as deemed necessary.
Benefits
- One week of paid vacation, accrued after three months of employment; two weeks of paid vacation with accrual starting in the second year.
- Six major paid holidays per year.
- Five sick days (40 hours), subject to the provisions of the NYS Paid Sick Leave Act.
- License reimbursement after one year of employment.
- Health insurance, subject to plan eligibility requirements.
- 401(k) matching eligibility after one year of employment.
- Benefits from Paychex, such as Payactiv.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
