New York Licensed Clinical Review Nurse

Job Summary

Analyzing prior authorization requests to determine medical necessity, the full-time remote New York Licensed Clinical Review Nurse will perform medical necessity reviews, coordinate with healthcare providers, and assist in educating teams on utilization processes.

Key responsibilities

• Perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines
• Coordinate with healthcare providers and interdepartmental teams to ensure timely review of services and requests
• Provide education on utilization processes to promote high-quality and cost-effective medical care

Required qualifications

• Bachelor's degree in Nursing (BSN) or graduation from an accredited school of nursing
• 2 to 4 years of related experience in clinical review or utilization management
• Active New York RN license
• Knowledge of Medicare and Medicaid regulations preferred
• Clinical knowledge to analyze authorization requests and determine medical necessity of service preferred