New York Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Prior Authorization.

Key Responsibilities

• Analyze prior authorization requests to determine medical necessity and appropriate level of care
• Coordinate with healthcare providers and interdepartmental teams to ensure timely review and authorization of services
• Maintain compliance with regulatory guidelines by documenting and managing member's clinical information

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience in clinical review or medical management
• NYS RN license required; LPN or RN state licensure also required
• Clinical knowledge to analyze authorization requests preferred
• Familiarity with Medicare and Medicaid regulations preferred