RN Clinical Reviewer (Proofer)

RN Clinical Reviewer (Proofer) - Jericho, NY (#25289)

Location: Jericho, NY
Employment Type: Full-time, Temp-to-Hire
Hourly Rate: $45/hr

Position Overview:

Greenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Proofer Registered Nurse who will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their 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.

Why Join Us?

• Competitive Compensation: Earn $45 per hour.
• Comprehensive Benefits:
• Paid Sick Time
• Health insurance
• 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 (5 days per week), Temp-to-Hire position.
• Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment, enhancing skills in clinical review.
• Impactful Work: Play a critical role in ensuring the accuracy and integrity of state-level healthcare dispute resolutions.

Qualifications:

• Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York.
• Licensure: Must have an active NY State RN license.
• Experience: Must have a minimum of 2 years experience in an acute care facility, preferably in medicine/surgery or special care units, and/or 1 to 3 years experience in acute care utilization review.
• Technical Skills: Knowledge and experience with electronic medical records, including coding, quality, and clinical charting.
• Soft Skills: 
  • 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

Key Responsibilities:

This individual will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their 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.

• Conduct utilization reviews up to and including the appeal level. This includes the chart screen, complete electronic worksheets, entering required information, and making level one denial decisions when necessary.
• Conduct quality and clinical study data collection reviews. This includes a 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.
• Other activities as may be deemed necessary.

Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives