Registered Nurse Clinical Reviewer / IDR
About The Position
Greenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer to fill an opening with a Non-profit organization located in Albany, NY. This remote to office-based position involves conducting comprehensive medical-legal reviews, research, and appeals while ensuring regulatory compliance and producing accurate final determinations for a respected non-profit organization. Why Join Us? Work Schedule: Full-time, Remote to Office-Based position Professional Growth: Gain valuable experience in medical-legal review and dispute resolution processes Impactful Work: Contribute to fair and accurate resolution of healthcare disputes
Requirements
- Baccalaureate degree in Nursing or a graduate of an approved RN program
- Current New York State RN license
- 3+ years in Med-Legal review setting; 1-3 years in acute care utilization review/appeals
- Experience with electronic medical records; strong research and documentation abilities
- Excellent written/verbal communication; ability to work independently and collaboratively; flexible, innovative, and creative; the ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff; meets deadlines in time-sensitive environments
Responsibilities
- Conduct reviews up to and including the appeal level. This includes chart screen, 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
Benefits
- Competitive Compensation: Earn $50 per hour
- Comprehensive Benefits: 1 Week of Paid Vacation based on accruals after 6 months of employment (2 weeks of Paid Vacation with accrual starting your second year of employment)
- 6 Major Paid Holidays per year after 6 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
