Clinical Nurse Reviewer (RN)
Horizon Healthcare Staffing
Description
Job Title: Clinical Nurse Reviewer (RN)
Location: Nassau County, NY
Schedule: Monday through Friday
Hours: 8:30am - 5:00pm
- $45 per hour
- 12-week assignment (Start January 1, 2025)
- Office position
Job Description:
Horizon Healthcare Staffing is searching for a Clinical Nurse Reviewer (RN) for one of our clients located in Nassau County, NY. The Clinical Nurse Reviewer (RN) will oversee and execute a wide range of activities associated with State and Federal Independent Dispute Resolution (IDR) case determinations. This role involves conducting clinical-level reviews, Prior Authorization assessments, and disputed benefits reviews. The Clinical Nurse Reviewer will collaborate closely with Medical Review Analysts and Physician Consultants to ensure a thorough and accurate review process.
Responsibilities
Responsibilities:
- Conduct comprehensive reviews, including appeals, by performing chart screens, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations.
- Serve as a resource for administrative and clinical staff by offering training, problem-solving support, and clarification on determinations. Provide technical assistance and participate in staff huddles.
- Train and mentor new Registered Nurses (RNs) as the project grows and expands.
- Conduct claims assessment and adjudication.
- Participate actively in collaborative training sessions.
- Perform additional activities as deemed necessary.
Qualifications
Qualifications:
- Proficiency in electronic medical records systems.
- RN license in NY
- Minimum of 2 years’ clinical experience in a healthcare setting is required
- Bachelor’s degree required
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