Registered Nurse Clinical Reviewer

GreenLife Healthcare Staffing • Jericho, NY

3d • Onsite

About The Position

Greenlife Healthcare Staffing is seeking a Registered Nurse Clinical Reviewer / IDR to join a Non-profit organization in Jericho, New York. This role is designed for an experienced RN with a background in utilization review or appeals, who excels in an independent, collaborative, and deadline-oriented setting. The position offers professional growth in independent dispute resolution (IDR), medical-legal review, and appeals within a supportive non-profit environment, contributing to improved 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 administrative and clinical staff in training, problem-solving, and clarifying determinations.
• Provide technical assistance and conduct/participate in staff huddles.
• Participate in collaborative training.
• Perform 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

What This Job Offers

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