As a Clinical Reviewer (RN), 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 for Rhode Island. Duties include but are not limited to:
- Conduct utilization reviews up to and including the appeal level. This includes admission screening of medical, surgical, rehabilitation and psychiatric charts. Process authorizations, discharges, and waivers. Conduct concurrent and retrospective reviews.
- Conduct quality and clinical study data collection reviews. This includes collaboration of annual psychiatric reports and long-term mental health reviews.
- Act as a resource for the administrative staff in training, problem solving, and clarifying procedures.
- Participate in collaborative training specific to clinical study objectives.
This position is office based at our Jericho, NY office.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.
EDUCATION & EXPERIENCE:- New York State, Licensed Registered Nurse required. Rhode Island Licensed Registered Nurse, preferred or willing to obtain Rhode Island licensure upon onboarding.
- A bachelor's degree in Nursing OR graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York, required.
- Minimum of two (2) years' experience in an acute care setting preferably in medicine/surgery or special care areas. In addition, candidates should also possess one (1) to three (3) years experience in acute care utilization review, including extensive experience with prior authorization process.
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 hourly rate for this position is $38.46 - $43.27. Actual salary 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.
