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.

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.

Why Join Us?

• Competitive Compensation: Earn a competitive rate of $50 per hour.
• Comprehensive Benefits:
• 1 Week of Paid Vacation based on accruals after 3 months of employment (2 weeks of Paid Vacation with accrual starting your second year of employment)
• 6 Major Paid Holidays per year
• 5 Sick Days (40 Hours) subject to the provisions of the NYS Paid Sick Leave Act
• License Reimbursement after 1 year of employment
• Health insurance is subject to plan eligibility requirements
• 401k Matching eligibility after 1 year of employment
• Benefits from Paychex, such as Payactiv
• GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.
• Work Schedule: Full-time position, Monday to Friday, with remote work flexibility.
• Professional Growth: Gain valuable experience in utilization review, quality improvement, and clinical study data collection within a supportive non-profit environment.
• Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes through thorough clinical reviews and evidence-based determinations.