Job Description

Job Description

Job Description

As a Clinical Reviewer you will complete the full spectrum of activities related to State Independent Review Organization (IRO) case determinations. You will conduct clinical level review, determine physician level assignment, manage case staging between external physician experts and manage appeal processes within strict deadlines. Duties include but are not limited to:

• Conducting 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.
• Understanding multi-state requirements.
• Participate in collaborative training.

This position is 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 & EXPERINCE:

• 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 range for this position is $38.461 – $43.269. 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 Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.

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