New York Licensed Clinical Review Nurse

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

Key Responsibilities

Analyzes prior authorization requests to determine medical necessity and appropriate level of care

Coordinates with healthcare providers and interdepartmental teams to ensure timely reviews and authorizations

Documents and maintains member clinical information to ensure compliance with regulatory guidelines

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