REMOTE Review Nurse (NY License) - 248365

Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.

Job Title: Clinical Reviewer (RN) Reports To: Director / Assistant Director Position Overview: We are seeking a detail-oriented and experienced Registered Nurse to join our team as a Clinical Reviewer. This role is responsible for conducting comprehensive reviews related to State and Federal Independent Dispute Resolution (IDR) cases, prior authorizations, and disputed benefits. The Clinical Reviewer will support Medical Review Analysts and Physician Consultants to ensure accurate, timely, and compliant determinations. This is an excellent opportunity for a motivated RN in New York to apply clinical expertise in a dynamic and collaborative environment while contributing to fair and accurate case determinations.

Conduct clinical reviews up to the appeal level, including chart screening, regulatory guidance compilation, insurer research, electronic worksheet completion, and preparation of final determinations. Serve as a resource to administrative and clinical staff by providing training, problem-solving support, and clarification of determinations. Mentor and train new RNs as projects expand. Assess and adjudicate claims, collaborating with cross-functional teams as needed. Participate in collaborative trainings and other activities to support team objectives.