RN Clinical Reviewer – IDR

This is a fully remote position, open to applicants in New York.

📋 Description

• Perform reviews extending to the appeal level, which involves chart screening, compiling regulatory guidance, researching insurer requirements, filling out electronic worksheets, and preparing final determinations.

• Serve as a resource for both administrative and clinical staff by providing training, resolving issues, and clarifying determinations. Technical assistance will be offered, and participation in staff huddles is expected.

• Engage in collaborative training initiatives.

• Participate in additional activities as necessary.

⛳️ Requirements

• Education: Bachelor's degree in Nursing or graduation from an accredited RN program.

• Licensure: Must hold a current New York State RN license.

• Experience:

• - A minimum of 3 years in a Med-Legal review environment is required.

• - 1-3 years of experience in acute care utilization review or appeals is essential.

• Technical Skills: Proficiency with electronic medical records and strong research skills.

• Soft Skills: Exceptional written and verbal communication abilities; capacity to work autonomously; adaptable and innovative; capable of meeting deadlines in sensitive situations; strong collaboration and problem-solving skills.

🏝️ Benefits

• Competitive Compensation: $50 per hour.

• Comprehensive Benefits:

• - 1 week of paid vacation based on accrual after 3 months of employment (2 weeks of paid vacation with accrual beginning in the second year of employment).

• - 6 major paid holidays annually (after 3 months of employment).

• - 5 sick days (40 hours) in accordance with the NYS Paid Sick Leave Act.

• - License reimbursement after 1 year of employment.

• - Health insurance is subject to plan eligibility criteria.

• - 401(k) matching eligibility after 1 year of service.

• - Additional benefits from Paychex, including Payactiv.

• - GLHS is recognized as a desirable workplace, with a 93% retention rate for employees with over 2 years of service, positive Google reviews, and a commendable company culture.