Clinical Review Nurse - 247995 - Jericho, NY
3 weeks ago
Job summary
We're expanding and looking for an experienced Clinical Reviewer to support fair, compliant,
evidence-based case outcomes in the State and Federal Independent Dispute Resolution (IDR)
process.
- Clinical review up to appeal level
, including chart screening regulatory research insurer requirement review worksheet completion preparation final determinations. - Serve as clinical resource administrative clinical staff—supporting training problem-solving clarification determinations.
- Mentor new RN reviewers project grows claims assessment adjudication collaborative training initiatives support related activities needed manage daily caseload averaging IDR appeal cases ranging simple complex reviewing documentation codes out-of-network billing details determine next steps..
Job description
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