Job Overview - Clinical Review Nurse, RN (Hybrid): We re seeking a skilled Clinical Review Nurse to join our client's team in Nassau County, NY. In this hybrid role, you ll ensure smooth daily operations of the Clinical Review Department, including reviewing and authorizing provider services, with a focus on evidence-based medical necessity and regulatory compliance.
Compensation: $57/hour
Location: Nassau County, NY
Schedule: Monday to Friday (Hybrid)Responsibilities as the Clinical Review Nurse, RN: - Authorization Processing: Handle requests for service authorizations from in-network providers, ensuring timely communication of decisions made by the Interdisciplinary Team (IDT).
- Clinical Review: Collect, review, and evaluate necessary information to make decisions on prospective, concurrent, and retrospective cases using evidence-based criteria.
- Care Coordination: Suggest alternative care plans and collaborate with providers and the IDT to optimize service utilization.
- Case Documentation: Maintain accurate records of case reviews, communications, and outcomes in electronic case files.
- Medical Review: Present cases to the site Physician and/or Medical Director for timely review and determination.
- Quality Assurance: Participate in inter-rater reliability testing and refer potential quality of care concerns to Quality Management.
Qualifications for the Clinical Review Nurse, RN: - Education: BSN required.
- Experience: 3-5+ years of Clinical experience in a Hospital or Home Care setting.
- Preferred Experience: 2-3 years of Utilization Review experience at a Managed Care Organization preferred.
- Technical Skills: Proficiency in Microsoft Office and Excel.
- Travel: Ability to travel to various sites as required.
Application Notice: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, TAG MedStaffing will keep your resume on file for future opportunities and may contact you for further discussion.
