Registered Nurse Clinical Reviewer / AIMS - Remote

Registered Nurse Clinical Reviewer / AIMS - Remote (#25347)

Location: Remote (Jericho, NY)
Employment Type: Full-time
Hourly Rate: $50/hr

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

Greenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer / AIMS to fill an opening with a Non-profit organization located in New York. This remote position is ideal for an experienced RN with a background in acute care utilization review who is detail-oriented, flexible, and capable of working independently.

Registered Nurse Clinical Reviewer / AIMS - Remote (#25347)Location: Remote (Jericho, NY)Employment Type: Full-timeHourly Rate: $50/hrAbout Greenlife Healthcare Staffing:Greenlife Healthcare Staffing is a leading nationwide recruitment agency ...

Qualifications:

• Education: Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program.
• Licensure: Licensed as a Registered Professional Nurse in New York State.
• 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.
• Technical Skills:
• Knowledge and experience with electronic medical records (EMR), including utilization, quality, and clinical charting.
• Experience with InterQual and Milliman (MCG) criteria.
• Proficiency in completing electronic worksheets and data entry.
• Soft Skills:
• Ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal communication skills.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative.
• Strong attention to detail and ability to meet deadlines in a time-sensitive environment.

Key Responsibilities:

This individual will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their knowledge and expertise of the review program to conduct clinical level review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.

• Conduct utilization reviews up to and including the appeal level. This includes chart screen, complete electronic worksheets, enter required information and make level one denial decisions when necessary.
• Conduct quality and clinical study data collection reviews. This includes a chart review, complete detailed electronic data worksheets.
• Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles.
• Participate in collaborative training specific to clinical study objectives.
• Other activities as may be deemed necessary.