Clinical Reviewer
3 weeks ago
Job Title: Clinical Reviewer - Medical Professional
About the Role:
We are seeking a skilled Clinical Reviewer to join our team at Greenlife Healthcare Staffing. As a Clinical Reviewer, you will be responsible for conducting reviews up to and including the appeal level, compiling regulatory guidance, researching insurer requirements, and preparing final determinations.
Responsibilities:
- Conduct reviews up to and including the appeal level.
- Compile regulatory guidance and research insurer requirements.
- Prepare final determinations.
- Act as a resource for administrative and clinical staff in training, problem-solving, and clarifying determinations.
- Participate in collaborative training.
Requirements:
- Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program.
- Licensed to practice in the State of New York.
- Experience in a medical-legal review setting is preferred but not required.
- 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.
Benefits:
- $55 per hour salary.
Schedule:
- Full-time position (6 months contract).
- Contract may be extended beyond six months, contingent upon client demand and employee performance.
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