Clinical Reviewer (RN)
As a Clinical Reviewer, you will complete the full spectrum of activities related to Independent Dispute Resolution (IDR) case determinations. Conducting clinical level review, managing case staging and appeal processes within strict deadlines. Duties include but are not limited to:
• Conduct reviews up to and including the appeal level. This includes documentation screening, writing case summaries, determining documentation adequacy, researching insurer requirements, complete decision templates and preparing final determinations.
• Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations.
• Training and mentoring new RNs as the project expands.
• Participate in collaborative training.
This is an in office position based in IPRO's headquarter office located in Jericho, NY
QUALIFICATIONS:
• Knowledge and experience with electronic medical records.
• 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.
• Ability to meet deadlines in a time sensitive environment.
Education & Experience:
• New York Licensed Registered Nurse, required.
• A bachelor’s degree in nursing or graduate of an approved Registered Professional Nurses training program, required.
• Minimum of two (2) years’ experience in a clinical setting required.
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The hourly rate for this position is $38.46- $43.27. Actual salary and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.
The salary range and/or hourly rate listed does not include other forms of compensation or benefits.
IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status.
Skills Required
- New York Licensed Registered Nurse
- Bachelor's degree in nursing or graduation from an approved Registered Professional Nurses training program
- Minimum of two years of experience in a clinical setting
- Knowledge and experience with electronic medical records
- Ability to oversee, problem solve, and collaborate with medical, analytical, administrative, and clinical staff
- Excellent written and verbal communication skills
- Ability to work independently with little supervision
- Ability to meet deadlines in a time-sensitive environment
- Flexibility, innovation, and creativity
What We Do
IPRO is a non-profit organization that works with government agencies, providers and patients to implement innovative programs that bring policy ideas to life. For more than 40 years we’ve made creative use of clinical expertise, emerging technology, and data solutions to make the healthcare system work better. IPRO holds contracts with federal, state, and local government agencies, as well as private-sector clients, in more than 34 states and the District of Columbia. IPRO is headquartered in Jericho, NY and also has offices in Albany, NY; Hamilton, NJ; and Beachwood, OH. IPRO’s staff of more than 300 professionals includes physicians, registered nurses, mental health professionals, epidemiologists, biostatisticians, data analysts, medical record reviewers, health policy experts, pharmacists, coding professionals, claims analysts, auditors, programmers, systems analysts, web technology experts, and healthcare communications specialists. IPRO also retains a network of more than 300 board-certified physician consultants.
