New York Licensed RN Review Nurse

Job Summary

Analyzing prior authorization requests for medical necessity, the full-time New York Licensed RN Review Nurse will perform clinical reviews, collaborate with healthcare providers for timely service authorization, and maintain compliance with regulatory guidelines in a remote setting.

Key responsibilities

• Perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines
• Coordinate with healthcare providers and interdepartmental teams to assess and ensure timely authorization of care
• Document and maintain member clinical information in health management systems to ensure compliance with regulations

Required qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience in clinical review or authorization processes
• Clinical knowledge to analyze authorization requests and determine medical necessity
• Knowledge of Medicare and Medicaid regulations preferred
• Current New York RN license required