RN Clinical Reviewer / IDR - Remote to Office-Based Setting
$104,000–$104,000 year
Remote · United States
Job Summary
RN Clinical Reviewer (IDR) for a remote-to-office-based role supporting a non-profit organization in New York. Responsible for conducting comprehensive medical-legal reviews and appeals, including chart screening, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations. Acts as a resource for administrative and clinical staff, providing technical assistance, training, problem-solving, and participation in staff huddles. Requires current NY RN license, 3+ years in medical-legal review, 1-3 years in acute care utilization review/appeals, experience with electronic medical records, and strong written/verbal communication. Role offers full-time schedule, competitive compensation ($50/hr, $104,000 annualized), and a benefits package with vacation, holidays, sick leave, license reimbursement, health insurance eligibility, and 401(k) matching.
Required Qualifications
- Baccalaureate degree in Nursing or graduate of an approved RN program
- Current New York State RN license
- At least 3 years of Med-Legal review experience
- 1-3 years of acute care utilization review/appeals experience
- Experience with electronic medical records (EMR)
- Strong written and verbal communication
- Ability to work independently and meet deadlines in sensitive environments
- Ability to conduct reviews through appeal level, including chart screen, regulatory guidance, insurer requirements, electronic worksheets, and determinations
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