Clinical Reviewer (RN) Job at IPRO, Lake Success, NY

MGt3NHR1V1dVNG1SMnBrenlEMkpvV0d3QkE9PQ==
  • IPRO
  • Lake Success, NY

Job Description

As a Clinical Reviewer you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You will utilize your knowledge and expertise of the review program to conduct clinical level review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.  Duties include but are not limited to:

  • Conduct utilization reviews up to and including the appeal level.  This includes chart screen, complete electronic worksheets, enter required information and make level one denial decisions when necessary.
  • Conduct quality and clinical study data collection reviews. This includes chart review, complete detailed electronic data worksheets.
  • Act as a resource for the administrative staff in training, problem solving, and clarifying procedures.  Will provide technical assistance and conduct/participate in staff huddles.
  • Participate in collaborative training specific to clinical study objectives.

This position is based in IPRO's Headquarter office located in Lake Succes, NY. Potential opportunity for Hybrid option (3 days in office 2 days home) considered after initial orientation/training period.

QUALIFICATIONS:

  • Knowledge and experience with electronic medical records including utilization, quality, and clinical charting.
  • Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
  • Excellent written and verbal 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.

EDUCATION & EXPERINCE:
• New York Licensed Registered Nurse, required.
• A bachelor’s degree in nursing or graduate of an approved Registered Professional Nurses training program, required.
• Minimum of two (2) years’ experience in an acute care facility preferably in medicine/surgery or special care units; and/or one to three years’ experience in acute care utilization review, required. 

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $85,000.00 – $90,000.00.  Actual salary range and /or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.


The salary range and/or hourly rate listed does not include other forms of compensation or benefits.

IPRO is an Affirmative Action/Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Job Tags

Hourly pay, Full time, Flexible hours,

Similar Jobs

Concord Group Insurance

Recruiter Job at Concord Group Insurance

 ...Our Recruiter plays a key role in driving the future growth of Concord Group Insurance. Reporting to the Senior Talent Acquisition Lead...  ...Additionally, this role will be deeply involved in executing college campus recruiting strategies and managing partnerships with... 

Addison Kenway.

Dermatology Nurse Practitioner or Physician Assistant Job at Addison Kenway.

 ...institutions and diverse employment opportunities, making it ideal for families and professionals alike. Additionally, New Jersey provides a range of housing options, from charming suburban neighborhoods to bustling urban areas, ensuring there's something for everyone.... 

NP Now

Family Medicine with OB - C sections - Open to J1 / H1B Job at NP Now

 ...2-15 patients a day in the clinic ~ must be able to do OB and C sections About the group: ~300 team members ~2 MDs - Family Medicine with OB ~7 NPs ~2 locations ~ collegial and down to earth people open to J1 and H1B visa sponsorship candidates... 

American Income Life AO - Josh Olin

Calling All Recent College Graduates: Your Dream Career Starts Here Job at American Income Life AO - Josh Olin

 ...Calling All Recent College Graduates: Your Dream Career Starts Here! Launch Your Professional Journey with AO and Unlock Limitless Opportunities! Are you ready to step into the workforce and build a career that combines flexibility, professional growth, and exciting... 

Senior Helpers Mooresville

Corporate Pilot with AgingCare Do Not Delete Job at Senior Helpers Mooresville

Great people deserve a great place to work and Senior Helpers is hiring Caregivers in Mooresville, NC!Senior Helpers is proud to be the first and only national in-home care provider to receive certification as a Great Place to Work. Our caregivers and staff are treated...