RN - Utilization Review

NYC Health + Hospitals/Correctional Health Services is one of the nation's leading correctional health care systems in quality of, and innovations and access to care. In-jail services include medical, mental health, nursing, substance use treatment, social work, dental and vision care, discharge planning, and reentry support. In addition to providing direct patient care in the jails, CHS conducts enhanced pre-arraignment screening and forensic psychiatric examinations; and leverages the resources of the Health + Hospitals system to help discharged patients successfully return to their communities. CHS is also a pivotal partner in New York City's criminal justice reform efforts. Our workforce is comprised of more than 1,500 dedicated professionals, with locations in all five boroughs and on Rikers Island.

Under the direction of the Director and/or Deputy Director of Patient Relations, the RN Investigator will serve in a clinically focused role responsible for reviewing, assessing, and investigating patient complaints, concerns, and requests related to healthcare services provided within the City's jail system. The RN Investigator will apply clinical judgment, nursing expertise, and knowledge of healthcare operations to evaluate the quality, appropriateness, and continuity of patient care, while supporting patient safety, regulatory compliance, and quality improvement initiatives.

Specific Duties Include:

1. Review and clinically assess complaints, grievances, and requests received from internal and external stakeholders to identify key healthcare-related concerns and potential gaps in care delivery.
2. Conduct comprehensive clinical reviews of electronic health records (CHER) and other healthcare information systems to obtain relevant medical, nursing, and behavioral health information necessary for case resolution.
3. Analyze clinical findings and prepare detailed summaries addressing the medical and operational issues identified during investigations.
4. Collaborate with facility-based healthcare staff, interdisciplinary treatment teams, and administrative personnel.
5. Utilize professional nursing judgment to determine whether complaints are confirmed based on clinical documentation, patient interviews, applicable standards of care, and available evidence.
6. Prepare investigative findings, clinical recommendations, and case outcomes for review by CHS senior leadership and relevant clinical disciplines; recommend corrective or preventive actions when appropriate.
7. Participate in interdisciplinary case conferences with medicine, nursing, mental health, pharmacy and clinic administration leadership to review complex patient care concerns and system issues.
8. Provide clinically informed recommendations to improve patient care, patient safety, healthcare delivery, and overall patient experience.
9. Identify trends and contribute to the development of quality improvement and performance improvement initiatives aimed at enhancing clinical outcomes and reducing recurrence of patient complaints.
10. Conduct special clinical reviews, audits, and investigations related to healthcare services, patient care practices, as assigned.
11. Perform additional duties and special projects as assigned.

Department Preferences:

• Strong clinical assessment, analytical, and critical thinking skills with exceptional attention to detail.
• Experience conducting medical record reviews, clinical investigations, utilization review, quality assurance, risk management, or patient advocacy activities.
• Strong knowledge of medical, nursing, behavioral health, and correctional healthcare terminology and standards of care.
• Ability to communicate effectively with interdisciplinary healthcare teams, patients, and administrative leadership.
• Demonstrated interest in correctional health, public health, healthcare quality improvement, and patient-centered care.
• Commitment to ongoing professional development, and continuous quality improvement initiatives.

Skills

• 1 year of non-acute utilization review experience - required
• RN investigation and clinical/medical record review experience is required
• RN experience - preferred

Education

• New York State RN License
• Primary Source Verification
• AHA BLS

Schedule Notes

• Onsite role in Riker's Island.
• (PREA and DOC clearance is required)
• 8:30 AM-5:00 PM
• 37.50 hours/weekly

Department Name

• PATIENT RELATIONS

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