What are the responsibilities and job description for the RN Clinical Reviewer position at Winston Staffing?
As a Clinical Reviewer RN, you will complete the full spectrum of activities related to Independent Dispute Resolution (IDR) case determinations. Conducting clinical level review, managing case staging and appeal processes within strict deadlines. Duties include but are not limited to:
• Conduct reviews up to and including the appeal level. This includes documentation 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.
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.
Two Available Work Schedules:
Monday – Friday
Schedule # 1: 7:00 AM - 3:30 PM
Schedule #2: 2: 9:00 AM – 5:30 PM
Salary : $50 - $60
