This job is archived
(Archived) Registered Nurse/ Clinical Reviewer/ Remote
Job Description
JOB TITLE: Job #3774 - Registered Nurse/ Clinical Reviewer/ Remote – New York State
General Responsibilities:
This individual will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. Thus, conduct final level insurance appeals and will be reviewing medical records. They will utilize their knowledge and expertise of the review program to conduct a clinical level review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.
Compensation and Benefits for the Registered Nurse/ Clinical Reviewer/ Remote:
- The salary for this position is $45 per hour (Negotiable)
Benefits
- Weeks Vacation
- Major Holidays
- Personal Days
- Sick Days
- license reimbursement
- 401K
- Family Medical Leave
Schedule
- Full-time – COMPLETELY REMOTE
- Monday to Friday (9 AM-5:30 PM)
- Saturday or Sunday meeting (occasuanally)
Requirements for Registered Nurse/ Clinical Reviewer/ Remote
- Must have an active RN State license
- Must have 1-3 years of experience in acute care utilization review/appeals background.
- Must be comfortable working on a computer. Familiar with Outlook, spreadsheets, Word.
Responsibilities for Registered Nurse/ Clinical Reviewer/ Remote
- Conduct utilization reviews up to and including the appeal level. This includes chart screen, completing electronic worksheets, entering the 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