Clinical Review RN - 249588
JOB TITLE: Clinical Review RN (Medicaid Cost Outlier) - Remote
Must be licensed as an RN in NYS
* Nurse Background: 2+ years of acute care/medical surgical experience required. Utilization Review/Interqual/MCG experience a strong want. GENERAL 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. DUTIES: 1. 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. 2. Conduct quality and clinical study data collection reviews. This includes chart review, complete detailed electronic data worksheets. 3. 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. 4. Participate in collaborative training specific to clinical study objectives. 5. Other activities as may be deemed necessary. QUALIFICATIONS: 1. Licensed as a Registered Professional Nurse in New York State. 2. Knowledge and experience with electronic medical records including utilization, quality, and clinical charting. 3. Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff. 4. Excellent written and verbal skills. 5. Ability to work independently with little supervision. 6. Ability and desire to be flexible, innovative, and creative. EDUCATION & EXPERIENCE: 1. Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York. 2. A minimum of 2 years experience in an acute care facility preferably in medical surgical and utilization review experience highly preferable. LOCATION: Remote, can sit anywhere as long as you are licensed as an RN in NYS SHIFTS: M-F, 40 hours or 4x10s (no weekends) PAY: $48-52/hr DURATION: long term open ended contract includes benefits, sick time, 401k, weekly pay