RN Clinical Reviewer — Utilization & Quality Assurance

ADP, Inc.; Jericho (NY); On-site; USD 52,000 - 59,000; Full time

Job summary

IPRO in Jericho, NY is seeking a Clinical Reviewer (RN) to handle the full spectrum of utilization and quality reviews. This full-time, in-office role requires an NY RN license, with RI licensure preferred and a strong background in acute care utilization review.

The position emphasizes collaboration with medical and administrative staff, independent work capability, and adaptability in a dynamic healthcare setting.

Qualifications

• Knowledge and experience with electronic medical records including utilization, quality, and clinical charting.
• 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.

Responsibilities

• Conduct utilization reviews up to and including the appeal level; perform admission screening of medical, surgical, rehab and psychiatric charts.
• Process authorizations, discharges, and waivers; conduct concurrent and retrospective reviews.
• Conduct quality and clinical study data collection reviews; collaborate on psychiatric and long-term mental health reviews.
• Act as a resource for administrative staff in training, problem solving, and clarifying procedures.
• Participate in collaborative training specific to clinical study objectives.

Skills

EMR experience

Collaboration

Verbal and written communication

Independent work

Flexibility

Education

New York RN license

Rhode Island RN license preferred

Bachelor's degree in Nursing

Job description

IPRO in Jericho, NY is seeking a Clinical Reviewer (RN) to handle the full spectrum of utilization and quality reviews. This full-time, in-office role requires an NY RN license, with RI licensure preferred and a strong background in acute care utilization review.

The position emphasizes collaboration with medical and administrative staff, independent work capability, and adaptability in a dynamic healthcare setting.