Precision is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law.
Join our growing team of RN Utilization Quality Reviewers. Team members 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 support Medical Review Analysts, Program Review Associates and Physician Consultants to ensure an appropriate and accurate process.
Job is 100% Remote, but requires two week paid training in New York.
- Conduct utilization reviews up to and including the appeal level. This includes chart screen, complete electronic worksheets, enter required information and make referral decisions when necessary.
- Conduct quality and clinical study data collection reviews. This includes chart review, complete detailed electronic data worksheets.
- Act as a resource for the PSC/clerical 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.
- Licensed as a Registered Professional Nurse in New York State.
- 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.
EDUCATION & EXPERIENCE:
- Licensed as a Registered Professional Nurse in New York State, required.
- Graduate of an approved Registered Professional Nurses training program or Baccalaureate degree in Nursing, required.
- A minimum of two years’ experience in an acute care facility preferably in medicine/surgery or special care units; and/or one to three years’ experience in acute care utilization review, required.
- Knowledge and experience with electronic medical records including utilization and clinical charting, required.