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Registered Nurse Clinical Reviewer
- Location: Remote (New York).
- Employment Type: Full-time.
- Hourly Rate: $50/hr.
- Competitive Compensation: Earn a competitive rate of $50 per hour.
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Comprehensive 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.
- 5 Sick Days (40 Hours) subject to the provisions of the NYS Paid Sick Leave Act.
- License reimbursement after 1 year of employment.
- Health insurance is subject to plan eligibility requirements.
- 401k matching eligibility after 1 year of employment.
- 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 position, Monday to Friday, with remote work flexibility.
- Professional Growth: Gain valuable experience in utilization review, appeals, and quality improvement within a supportive non-profit environment.
- Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through thorough clinical reviews and evidence-based determinations.
- Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program.
- Licensure: Must have an active New York or Compact State license.
- Experience: Must have 1-3 years of experience in a utilization review/appeals background and prior authorization.
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Technical Skills:
- Must be comfortable working on a computer.
- Familiar with Outlook, spreadsheets (Excel), and Word.
- Experience with electronic medical records and electronic worksheets.
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Soft Skills:
- Excellent written and verbal communication skills.
- Ability to work independently with little supervision.
- Strong problem-solving skills and attention to detail.
- Ability to work collaboratively with peers, medical, analytical, and administrative support staff.
- Ability and desire to be flexible, innovative, and creative.
- Ability to meet deadlines in a time-sensitive environment.
- Conduct utilization reviews up to and including the appeal level. This includes chart screens, completing electronic worksheets, entering the required information, and making level one denial decisions when necessary.
- Conduct quality and clinical study data collection reviews. This includes chart reviews and completing detailed electronic data worksheets.
- Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. Provide technical assistance and conduct/participate in staff huddles.
- Participate in collaborative training specific to clinical study objectives.
- Perform other activities as may be deemed necessary.
