Clinical Reviewer

2 days ago


New Hyde Park, New York, United States IPRO Full time
Clinical Reviewer Job Description

As a Clinical Reviewer at IPRO, you will play a crucial role in ensuring the accuracy and appropriateness of healthcare services. Your expertise will be utilized to conduct clinical-level reviews, supporting Medical Review Analysts and Physician Consultants in their decision-making processes.

Key Responsibilities:

  • Conduct utilization reviews up to and including the appeal level, ensuring accurate and timely decision-making.
  • Collect and analyze quality and clinical study data, providing valuable insights for improvement.
  • Collaborate with administrative staff to provide training, problem-solving, and technical assistance.
  • Participate in collaborative training specific to clinical study objectives.

Requirements:

  • Knowledge and experience with electronic medical records, including utilization, quality, and clinical charting.
  • Ability to work collaboratively with peers, medical, analytical, and administrative support staff.
  • Excellent written and verbal communication skills.
  • Ability to work independently with minimal supervision.

Education and 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 an acute care facility, preferably in medicine/surgery or special care units; and/or one to three years' experience in acute care utilization review, required.

IPRO is an Equal Opportunity Employer:

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


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