Registered Nurse Clinical Reviewer / IDR

Registered Nurse Clinical Reviewer / IDR – Jericho, NY (#25154D)

Location: Jericho, NY
Employment Type: Full-time
Hourly Rate: $60/hr (based on experience)

Position Overview:

We are currently seeking a Registered Nurse Clinical Reviewer / IDR to fill an opening with a Non-profit organization located in Jericho, New York. This role is ideal for an experienced RN with a utilization review or appeals background who thrives in a collaborative, independent, and deadline-driven environment.

Why Join Us?

• Competitive Compensation: Earn a competitive rate of $60 per hour based on experience.
• 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 (after 3 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 position.
• Professional Growth: Gain valuable experience in independent dispute resolution (IDR), medical-legal review, and appeals within a supportive non-profit setting.
• Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through fair, evidence-based clinical determinations.

Qualifications:

• Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program.
• Licensure: Must be licensed as a Registered Professional Nurse in New York State.
• Experience:
  • 1–3 years of experience in utilization review and/or appeals background required.
  • Must have at least 3 years of experience in Med-Legal review setting.
• Technical Skills: Knowledge and experience with electronic medical records (EMR).
• Soft Skills:
  • Ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
  • Excellent written and verbal communication 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.
    

Key Responsibilities:

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