NY Licensed Senior RN Clinical Reviewer

Job Summary

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

Key Responsibilities

• Reviews prior authorization requests for medical necessity and appropriate level of care
• Collaborates with healthcare providers to ensure timely review and authorization of services
• Escalates complex authorization requests to Medical Directors when necessary

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 4 - 6 years of related experience in clinical review or utilization management
• New York RN Licensure required
• Advanced clinical knowledge and ability to analyze authorization requests preferred
• Strong knowledge of Medicare and Medicaid regulations preferred