Registered Nurse Clinical Reviewer
$124,800–$124,800 year
On-site · Jericho, New York, United States
Job Summary
Registered Nurse Clinical Reviewer / IDR for a nonprofit organization in Jericho, NY. Conduct reviews up to and including the appeal level, including chart screens, assembling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations. Serve as a resource for administrative and clinical staff in training, problem-solving, and clarifying determinations; provide technical assistance and participate in staff huddles; participate in collaborative training. Gain experience in independent dispute resolution (IDR), medical-legal review, and appeals within a mission-driven setting.
Required Qualifications
- Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program
- Licensure: Must be licensed as a Registered Professional Nurse in New York State
- Experience: 1–3 years of experience in utilization review and/or appeals background
- Must have at least 3 years of experience in Med-Legal review setting
- Technical Skills: Knowledge and experience with electronic medical records (EMR)
- Soft Skills: Excellent written and verbal communication; ability to work independently; problem-solving and collaboration; ability to meet deadlines
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