RN Clinical Reviewer

RN Clinical Reviewer - Jericho, NY (#25314)

Location: Jericho, NY
Employment Type: Full-time
Hourly Rate: $45/hr - $50/hr

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

We are seeking a skilled Registered Nurse Clinical Reviewer to join a team at a respected non-profit organization in Jericho, NY. This role combines clinical expertise with analytical review, focusing on utilization reviews, quality data collection, and appeal-level determinations to support healthcare quality improvement initiatives.

Why Join Us?

• Competitive Compensation: Earn $45 - $50 per hour, based on experience
• Comprehensive Benefits:
  • 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act
  • 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, Monday - Friday
• Professional Growth: Gain valuable experience in utilization review, quality improvement, and clinical data analysis
• Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through rigorous clinical review processes

Qualifications:

• Education: Baccalaureate degree in Nursing or graduate of approved Registered Professional Nurses training program
• Licensure: Active New York State RN license
• Experience:
  • Must have a minimum of two years of experience in an acute care facility, preferably in medicine/surgery or special care units; and/or one to three years of experience in acute care utilization review.
  • Knowledge and experience with electronic medical records, including utilization, quality, and clinical charting.
• 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:

• Conduct utilization reviews up to and including the appeal level. This includes chart screens, complete electronic worksheets, enter required information and make level one denial decisions when necessary.
• Conduct quality and clinical study data collection reviews. This includes 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.