RN Clinical Reviewer – IDR

📋 Description

• Conduct evaluations up to and including the appeal stage. This encompasses chart screening, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations.

• Serve as a resource for both administrative and clinical personnel by offering training, problem-solving assistance, and clarification of determinations. Will provide technical support and engage in staff huddles.

• Engage in collaborative training initiatives.

• Participate in additional activities as deemed necessary.

⛳️ Requirements

• Education: A Bachelor's degree in Nursing or completion of an accredited RN program.

• Licensure: A valid New York State RN license.

• Experience:

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

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

• Technical Skills: Familiarity with electronic medical records; strong research abilities.

• Soft Skills: Exceptional written and verbal communication; capability to work independently; adaptable and innovative; able to meet deadlines in sensitive situations; strong collaborative and problem-solving skills.

🏝️ Benefits

• Competitive Compensation: $50/hr.

• Comprehensive Benefits:

• 1 Week of Paid Vacation accrued after 3 months of employment (2 weeks of Paid Vacation beginning in your 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 available after 1 year of employment.

• Health insurance is subject to eligibility requirements of the plan.

• Eligibility for 401(k) Matching after 1 year of employment.

• Benefits from Paychex, including Payactiv.

• GLHS is an excellent workplace: 93% employee retention rate for over 2 years, positive Google reviews, and a great company culture.