New York Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse I.

Key Responsibilities

• Provides first level RN review for outpatient and ancillary prior authorization requests
• Completes data entry and correspondence for each review
• Acts as liaison between TRICARE beneficiaries and providers, identifying potential cases for management

Required Qualifications

• Graduate of Nursing program; BSN desired or Graduate in Clinical Psychology or Clinical Social Work
• Three years clinical experience in a health care environment; managed care experience desired
• NYS RN license & NYS Driver's License required
• For Fidelis Care only: NYS RN, OT or PT license required