As a Clinical Reviewer you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You will utilize your knowledge and expertise of the review program to conduct clinical level review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process. Duties include but are not limited to: Conduct utilization reviews up to and including the appeal level. This includes chart screen, complete electronic worksheets, enter required information and make level one denial 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 administrative 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. This position is based in IPRO's Headquarter office located in Lake Succes, NY. Potential opportunity for Hybrid option (3 days in office 2 days home) considered after initial orientation/training period.
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