Registered Nurse Clinical Reviewer / IDR
About The Position
Greenlife Healthcare Staffing is 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. This position offers professional growth in independent dispute resolution (IDR), medical-legal review, and appeals within a supportive non-profit setting. The role allows for impactful work contributing to a mission-driven organization dedicated to improving patient outcomes through fair, evidence-based clinical determinations.
Requirements
- Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program.
- Licensed as a Registered Professional Nurse in New York State.
- 1–3 years of experience in utilization review and/or appeals background required.
- At least 3 years of experience in Med-Legal review setting.
- Knowledge and experience with electronic medical records (EMR).
- 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.
Responsibilities
- Conduct reviews up to and including the appeal level.
- Compile regulatory guidance.
- Research insurer requirements.
- Complete electronic worksheets.
- Prepare final determinations.
- Act as a resource for the administrative and clinical staff in training, problem-solving, and clarifying determinations.
- Provide technical assistance and conduct/participate in staff huddles.
- Participate in collaborative training.
- Other activities as may be deemed necessary.
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
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
