REMOTE Review Nurse (NY License) - 248365

Job Title: Clinical Reviewer (RN)

Reports To: Director / Assistant Director

Position Overview:

We are seeking a detail-oriented and experienced Registered Nurse to join our team as a Clinical Reviewer. This role is responsible for conducting comprehensive reviews related to State and Federal Independent Dispute Resolution (IDR) cases, prior authorizations, and disputed benefits. The Clinical Reviewer will support Medical Review Analysts and Physician Consultants to ensure accurate, timely, and compliant determinations.

Key Responsibilities:

• Conduct clinical reviews up to the appeal level, including chart screening, regulatory guidance compilation, insurer research, electronic worksheet completion, and preparation of final determinations.
• Serve as a resource to administrative and clinical staff by providing training, problem-solving support, and clarification of determinations.
• Mentor and train new RNs as projects expand.
• Assess and adjudicate claims, collaborating with cross-functional teams as needed.
• Participate in collaborative trainings and other activities to support team objectives.

Qualifications:

• Licensed Registered Nurse (RN) in New York State required.
• Must reside in New York State .
• Bachelor’s degree in Nursing or completion of an approved Registered Nurse training program required.
• Minimum of two years of clinical experience required.
• Proficiency with electronic medical records.
• Strong written and verbal communication skills.
• Ability to work independently, meet deadlines, and collaborate effectively with peers, medical staff, and administrative teams.
• Flexible, innovative, and able to adapt to a fast-paced, time-sensitive environment.

Why Join Us:

This is an excellent opportunity for a motivated RN in New York to apply clinical expertise in a dynamic and collaborative environment while contributing to fair and accurate case determinations.