Registered Nurse Clinical Reviewer / AIMS
New
G
Greenlife Healthcare StaffingHealthcare utilization review
Remote (Jericho, NY)TemporaryJunior
Salary50 USD per hour
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Job Details
- Experience
- A minimum of two (2) years of experience in an acute care facility, preferably in medicine/surgery or special care units; and/or one to three (3) years of experience in acute care utilization review.
- Required Skills
- Data entry
Requirements
- Hold a Baccalaureate degree in Nursing or be a graduate of an approved Registered Professional Nurses training program.
- Be licensed as a Registered Professional Nurse in New York State.
- Have at least two years of experience in an acute care facility, preferably in medicine/surgery or special care units, and/or one to three years of acute care utilization review experience.
- Have knowledge and experience with electronic medical records, including utilization, quality, and clinical charting.
- Have experience with InterQual and Milliman (MCG) criteria.
- Be proficient in completing electronic worksheets and data entry.
- Be able to oversee, problem-solve, and collaborate with peers and medical, analytical, and administrative support staff.
- Have excellent written and verbal communication skills.
- Be able to work independently with little supervision.
- Be flexible, innovative, and creative, with strong attention to detail and the ability to meet deadlines in a time-sensitive environment.
Responsibilities
- Conduct utilization reviews up to and including the appeal level.
- Screen charts, complete electronic worksheets, enter required information, and make level-one denial decisions when necessary.
- Conduct quality and clinical study data collection reviews, including chart reviews and detailed electronic data worksheets.
- Support Medical Review Analysts and Physician Consultants in the clinical review process.
- Provide administrative staff with training, problem-solving support, and procedural clarification.
- Provide technical assistance and conduct or participate in staff huddles.
- Participate in collaborative training specific to clinical study objectives.
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