Registered Nurse Clinical Reviewer/CPD - Remote

Registered Nurse Clinical Reviewer / CPD - Remote (#25295)

Location: Remote
Employment Type: Full-Time
Hourly Rate: $45/hr - $50/hr

Position Overview:

We are seeking a dedicated and detail-oriented Registered Nurse Clinical Reviewer for a fully remote opportunity with a mission-driven Non-profit organization. In this role, you will be responsible for conducting utilization and quality reviews, making critical decisions, and contributing to clinical studies, all from the comfort of your home.

Why Join Us?

• Competitive Compensation: Earn a highly competitive hourly rate of $45 - $50.
• 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
  • 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
  • 401k 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: Enjoy the flexibility and work-life balance of a fully remote position.
• Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment.
• Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes.

Qualifications:

• Education: Graduate of an accredited nursing program.
• Licensure: Must have an active and unrestricted New York State Registered Nurse (RN) license.
• Experience: 1-3 years of experience in acute care utilization review and appeals.
• Technical Skills: Proficient with computers; familiar with Microsoft Outlook, spreadsheets (Excel), and Word.
• Soft Skills: Strong analytical, problem-solving, and communication skills. Ability to work independently and act as a resource for administrative staff.

Key Responsibilities:

• Conduct utilization reviews up to and including the appeal level, including chart screens, completing electronic worksheets, and making level one denial decisions when necessary.
• Perform quality and clinical study data collection reviews, which involve detailed chart reviews and completing electronic data worksheets.
• Act as a resource for administrative staff by providing training, technical assistance, problem-solving, and clarifying procedures.
• Participate in collaborative training specific to clinical study objectives and staff huddles.
• Perform other duties as assigned to support the team and organizational goals.