As a Clinical Reviewer you will complete the full spectrum of activities related to State Independent Review Organization (IRO) case determinations. Conducting clinical level review, determining physician level assignment, managing case staging between external physician experts and manage appeal processes within strict deadlines. Duties include but are not limited to:
• Conduct reviews up to and including the appeal level. This includes chart 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.
Potential opportunity for Hybrid option (3 days in office 2 days home) considered after initial orientation/training period.
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 annualized salary range for this position is $85,000.00 – $90,000.00. Actual salary range 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 Affirmative Action/Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity or expression, disability, protected veteran status or military status.
...personalized care that helps patients achieve the best-possible outcomes - one patient, one partner, one therapy at time. Purpose The Pharmacist Triage Technician works with the pharmacist team in providing medication to the patient. Making inbound and outbounds calls for...
...Their ideal candidate has experience leading a small team and managing private homes, private clubs, or luxury hotels. Their goal is to... ...private families in roles such as Chief of Staff, Estate Manager, House Manager, Senior Butler, etc. Knowledge and experience in HR...
...Instructional Designer 1 Montana Technological University provides a comprehensive benefits package for all eligible positions that includes health, dental and vision insurance, mandatory retirement plan with employer contribution, partial tuition waiver, and a wellness...
...Job Title: Medical Writer Job Location: United States Job Location Type: Remote Job Contract Type: Full-time Job Seniority Level: Entry level At MJH Life Sciences our success is measured by your success! If you set your standards high and want...
...Position Title: Psych Nurse Practitioner / Mid-level - Part Time - Pamunkey Regional Jail Location: Hanover, VA Salary Range: $75.00 - $90.00 Hourly We are currently seeking a part time Psych Nurse Practitioner to join our team at Pamunkey...