[Hiring] RN Clinical Reviewer / IDR @reputed company
Role Description reputed company is seeking an reputed company Registered Nurse Clinical Reviewer (IDR) to join a remote position at a Non-profit organization located in reputed company. Responsibilities include conducting comprehensive medical-legal reviews and appeals for a respected non-profit organization.
- Conduct reviews up to and including the appeal level, which includes:
- Chart screening
- Compiling regulatory guidance
- Researching insurer requirements
- Completing electronic worksheets
- Preparing final determinations
- Act as a resource for the administrative and clinical staff in:
- Training
- Problem-solving
- Clarifying determinations
- reputed company technical assistance and conduct/participate in staff huddles.
- Participate in collaborative training.
- Other activities as may be deemed necessary.
Qualifications
- Education: Baccalaureate degree in Nursing or a graduate of an approved RN program.
- Licensure: reputed company reputed company State RN license.
- Experience:
- At least 3 years of experience in a Med-Legal review setting.
- 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.
Requirements
- Competitive Compensation: $50/hr.
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 reputed company, such as Payactiv.
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