Administrative Skills, Analysis Skills, Clinical Nursing, Communication Skills, Electronic Medical Records, Employee Retention, Health Insurance, Healthcare, Legal, Legal Appeals, Nonprofit, Nursing Credentials, Patient Care, Presentation/Verbal Skills, Problem Solving Skills, Registered Nurse (RN), Regulations, Reimbursement, Staff Training, Team Player, Technical Support, Time Management, Training Program, Utilization Management, Writing Skills
Registered Nurse Clinical Reviewer / IDR – Jericho, NY (#25154C)
Location: Jericho, NY
Employment Type: Full-time
Hourly Rate: $60/hr (based on experience)
Position Overview:
Greenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer / IDR to fill an opening with a Non-profit organization located in Jericho, New York. This role is ideal for an experienced RN with a utilization review or appeals background who thrives in a collaborative, independent, and deadline-driven environment.
Why Join Us?
- Competitive Compensation: Earn a competitive rate of $60 per hour based on experience.
- Comprehensive Benefits:
- 1 Week of Paid Vacation based on accruals after 3 months of employment (2 weeks of Paid Vacation with accrual starting your second year of employment)
- 6 Major Paid Holidays per year (after 3 months of employment)
- 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act
- License Reimbursement after 1 year of employment
- Health insurance is subject to plan eligibility requirements
- 401(k) Matching eligibility after 1 year of employment
- Benefits from Paychex, such as Payactiv
- GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.
- Work Schedule: Full-time position.
- Professional Growth: Gain valuable experience in independent dispute resolution (IDR), medical-legal review, and appeals within a supportive non-profit setting.
- Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through fair, evidence-based clinical determinations.
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 required.
- 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:
- Ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
- Excellent written and verbal communication skills.
- Ability to work independently with little supervision.
- Ability and desire to be flexible, innovative, and creative.
- Ability to meet deadlines in a time-sensitive environment.
Key Responsibilities:
- Conduct reviews up to and including the appeal level. This includes chart screens, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations.
- Act as a resource for the administrative and clinical staff in training, problem-solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles.
- Participate in collaborative training.
- Other activities as may be deemed necessary.
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Greenlife Healthcare Staffing