Clinical Reviewer

3 weeks ago


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

As a Clinical Reviewer at IPRO, you will play a critical role in ensuring the accuracy and appropriateness of medical reviews. Your expertise will be utilized to conduct thorough 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, including chart screening, electronic worksheet completion, and level one denial decisions.
  • Perform quality and clinical study data collection reviews, including chart review and detailed electronic data worksheet completion.
  • Act as a resource for administrative staff, providing training, problem-solving, and procedural clarification.
  • 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.
Qualifications:
  • New York Licensed Registered Nurse, required.
  • Bachelor's degree in nursing or graduate of an approved Registered Professional Nurses training program, required.
  • Minimum of two 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.

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