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As a Clinical Reviewer you will complete the full spectrum of activities related to State Independent Review Organization (IRO) case determinations. Conducting clinical level review, determining physician level assignment, managing case staging between external physician experts and manage appeal processes within strict deadlines. Duties include but are not limited to:
• Conduct reviews up to and including the appeal level. This includes chart screening, writing case summaries, determining documentation adequacy, researching insurer requirements, complete decision templates and preparing final determinations.
• Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations.
• Training and mentoring new RNs as the project expands.
• Participate in collaborative training.
Potential opportunity for Hybrid option (3 days in office 2 days home) considered after initial orientation/training period.
QUALIFICATIONS:• Knowledge and experience with electronic medical records.
• Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal skills.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative.
• Ability to meet deadlines in a time sensitive environment.
Education & 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 a clinical setting required.
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $75,000.00 – $90,000.00. Actual salary range and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.
The salary range and/or hourly rate listed does not include other forms of compensation or benefits.
IPRO is an Affirmative Action/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.
Full Time
Insurance
$79k-104k (estimate)
05/12/2024
07/11/2024
ipro-inc.com
CALHOUN, GA
25 - 50
Private
CHARLES HARVEY MAXWELL
$5M - $10M
Insurance
The job skills required for Clinical Reviewer (RN) include Problem Solving, etc. Having related job skills and expertise will give you an advantage when applying to be a Clinical Reviewer (RN). That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Clinical Reviewer (RN). Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Clinical Reviewer (RN) positions, which can be used as a reference in future career path planning. As a Clinical Reviewer (RN), it can be promoted into senior positions as a Clinical Data Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Clinical Reviewer (RN). You can explore the career advancement for a Clinical Reviewer (RN) below and select your interested title to get hiring information.