Registered Nurse Clinical Reviewer / IDR
$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. Role involves conducting reviews up to the appeal level, chart screens, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations. Acts as a resource for staff training, problem-solving, and clarifying determinations; participates in collaborative training and team huddles. Requires NY RN licensure, a Baccalaureate degree in Nursing, 1–3 years of utilization review and/or appeals experience, and at least 3 years in a Med-Legal review setting. Proficiency with EMR and strong written/verbal communication, independence, and deadline-driven performance are essential.
Required Qualifications
- Registered Nurse license in New York State
- Baccalaureate degree in Nursing or graduate of an approved RN program
- 1–3 years of experience in utilization review and/or appeals
- 3+ years of experience in Med-Legal review setting
- Knowledge of electronic medical records (EMR)
- Excellent written and verbal communication skills
- Ability to work independently with little supervision
- Ability to meet deadlines in a time-sensitive environment
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