New York Licensed Review RN

Job Summary

A company is looking for a Professional, Prospective Review RN.

Key Responsibilities

• Conduct comprehensive reviews of medical records and treatment plans to assess the appropriateness of services
• Evaluate medical necessity and collaborate with Medical Directors on proposed treatments and equipment
• Document clinical findings and communicate with healthcare providers and members regarding review outcomes

Required Qualifications, Training, and Education

• Current RN license in NY or VT
• Minimum of 3-5 years of clinical experience required
• Case management certification preferred
• Prior utilization review experience preferred
• Knowledge of government insurance programs (Medicare, Medicaid) is beneficial