New York Licensed Clinical Review Nurse
- Full-time
A company is looking for a Clinical Review Nurse - Prior Authorization.
Key Responsibilities
Analyze prior authorization requests to determine medical necessity and appropriate level of care
Coordinate with healthcare providers and teams to ensure timely reviews of services and requests
Document and maintain member clinical information in health management systems for compliance
Required Qualifications, Training, and Education
Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience preferred
Active New York State nursing license required
Knowledge of Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred
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Clinical Review Nurse • Lexington, Kentucky, United States