Conduct utilization review and clinical assessment of complaints, grievances, and requests to identify care concerns and potential gaps in care delivery. Review electronic health records and healthcare information systems, then summarize findings and make clinically informed recommendations that support patient care, safety, and experience. Collaborate with interdisciplinary teams and administrative staff while also taking part in case conferences, quality improvement work, audits, and investigations.
Key Responsibilities
- Conduct clinical reviews of complaints, grievances, and requests to identify healthcare-related concerns.
- Review electronic health records and other healthcare information systems for medical, nursing, and behavioral health information.
- Analyze findings and prepare written summaries, investigative findings, clinical recommendations, and case outcomes.
- Collaborate with healthcare staff, interdisciplinary treatment teams, and administrative personnel.
- Participate in interdisciplinary case conferences.
- Identify trends and support quality improvement initiatives, clinical reviews, audits, and investigations.
- Provide recommendations aimed at improving patient care, patient safety, healthcare delivery, and patient experience.
Required
- Associate’s degree in Nursing from an accredited educational institution.
- Active New York State RN license with primary source verification.
- AHA BLS certification.
- At least 1 year of non-acute utilization review experience.
Benefits & Perks
- Hourly pay of $60 to $64.
- Weekly pay up to $2,940.
- Comprehensive healthcare coverage, including medical, dental, and vision plans.
- Supplemental insurance options, including accident, critical illness, and hospital indemnity coverage.
- 401(k) retirement savings plan.
- Life and disability insurance.
- Employee assistance program, legal support, and employee discounts with preferred vendors.
- Auto, home, and pet insurance options.