Registered Nurse / Medicaid Clinical Reviewer – Remote
Registered Nurse / Medicaid Clinical Reviewer – Remote (#25291) Location: Remote | Postal Code: 10018 Employment Type: Full-Time Hourly Rate: $45 – $50/hr (Based on Experience) Greenlife Healthcare Staffing is seeking a Registered Nurse – Medicaid Clinical Reviewer to join a respected non-profit organization. This fully remote role allows you to make a meaningful impact while maintaining work-life balance. ✅ Why Join Us ✔️ Competitive Pay: Earn $45–$50/hr depending on experience. ✔️ Comprehensive Benefits: Paid Vacation (based on accruals) 6 Major Paid Holidays per year 5 Sick Days (40 Hours) under NYS Paid Sick Leave Act License Reimbursement after 1 year Health Insurance (subject to eligibility) 401(k) Matching after 1 year Paychex Benefits including Payactiv access ✔️ Strong Company Culture: 93% employee retention (2+ years), great reviews, and supportive leadership. ✔️ Schedule: Monday–Friday, 9:00 AM–5:30 PM (Fully Remote). ✔️ Impact & Growth: Join a mission-driven team improving Medicaid care quality while advancing your career. ✅ Key Responsibilities ✔️ Conduct utilization and quality reviews, including appeals, chart screenings, and medical record assessments. ✔️ Perform final-level insurance appeals and review inpatient high-cost hospital stays using InterQual criteria. ✔️ Review and validate itemized bills; prepare written responses for hospitals. ✔️ Collect and analyze clinical study data and participate in collaborative training. ✔️ Support administrative staff through training and procedural guidance. ✅ Qualifications ✔️ Education: Graduate of an accredited nursing program. ✔️ Licensure: Active RN license and active NY State license. ✔️ Experience: 1–3 years in case review, utilization, billing, or coding review; InterQual and Milliman experience required. ✔️ Technical Skills: Proficiency with Microsoft Outlook, Word, and spreadsheets. ✔️ Soft Skills: Analytical mindset, attention to detail, and ability to work independently in a remote setting.