Registered Nurse Clinical Reviewer / IDR

Registered Nurse Clinical Reviewer / IDR - Remote to Office-Based Setting - Jericho, NY (#25310)

Location: Hybrid (Remote to Office-Based) - Jericho, NY
Employment Type: Full-time
Hourly Rate: For remote, it's $50/hr, and as soon as the candidate transitions into an office-based position, the rate will be increased to $60/hr

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. This hybrid role combines remote work with office-based responsibilities, focusing on conducting comprehensive medical-legal reviews and appeals for a respected non-profit organization.

Why Join Us?

• Competitive Compensation: For remote, it's $50/hr, and as soon as the candidate transitions into an office-based position, the rate will be increased to $60/hr.
• Comprehensive Benefits:
  • Paid Vacation (after 6 months of employment)
  • 6 Major Paid Holidays per year (after 6 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, Hybrid (Remote to Office-Based)
• Professional Growth: Gain valuable experience in medical-legal review and dispute resolution
• Impactful Work: Contribute to fair resolution processes in healthcare disputes

Qualifications:

• Education: Baccalaureate degree in Nursing or a graduate of an approved RN program.
• Licensure: Current New York State RN license
• Experience: 
  • Must have at least 3 years of experience in a Med-Legal review setting.
  • Must have 1-3 years of experience in acute care utilization review/ appeals background.
• Technical Skills: Experience with electronic medical records; strong research capabilities
• Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills

Key Responsibilities:

• Conduct reviews up to and including the appeal level. This includes chart screen, 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