Nurse Clinical Reviewer

Full-Time | 40 Hours/Week | Hybrid/On-Site | New York Metropolitan Area
Reports To: Sr. Director, Maternal Child Health Programs

About the Role

We are seeking a highly organized and detail-oriented Clinical Reviewer RN to support quality assurance efforts across school-based health centers and family planning clinics. This role involves reviewing primary, preventive, and reproductive health services-including conducting on-site clinic observations-to ensure adherence to regulatory standards and program guidelines. The ideal candidate is analytical, communicative, and comfortable working both independently and within a collaborative team.

What You'll Do

Complete all pre-review preparation, including reviewing previous monitoring results and program documentation.
Conduct hybrid monitoring activities, including patient record and billing review for all required components and time frames.
Perform on-site clinic observations and conduct interviews with staff; identify and document any deficiencies.
Provide technical assistance to clinic/program personnel as needed.
Use standardized data tools to draft provider monitoring reports based on findings.
Track documents, review statuses, and data updates within shared platforms and databases.

Qualifications

Ability to work independently and as part of a team, with strong prioritization skills.
Strong analytical, written, and verbal communication skills.
Ability to gather and interpret information from records, reports, and multiple sources.
Proficiency with standard office technology and Microsoft applications (Word, Excel, Teams).
Ability to travel throughout the metropolitan area, including Westchester and Long Island (approx. 25 on-site days/year).

Education & Experience

Active New York State credential/registration (e.g., Registered Professional Nurse).
Bachelor's degree in Nursing OR graduation from an approved Registered Professional Nursing program (required).
Minimum of 2 years of clinical experience in pediatric, adolescent, or reproductive health (preferred).
Minimum of 2 years of experience with chart reviews for quality improvement or utilization review (preferred).

Schedule

40 hours per week, between 7:30 AM-5:30 PM
Hybrid/onsite requirements based on monitoring assignments

Training & Support

New hires receive approximately 3 months of hands-on training, including 1:1 support, team meetings, and step-by-step guidance to ensure full readiness before completing reviews independently. We are committed to equipping every team member for success.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Medix

Latest Jobs

Clinical Reviewer RN - School Based Programs