New York Licensed Clinical Review Nurse

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