New York Utilization Review Nurse

A company is looking for a Utilization Review Nurse I to provide clinical review for outpatient and ancillary services requiring authorization.

Key Responsibilities

Conducts first level RN review for outpatient and ancillary prior authorization requests for medical appropriateness and necessity

Completes data entry and correspondence related to each review, and documents rate negotiations accurately

Acts as a liaison between TRICARE beneficiaries and providers, referring potential quality issues and suspected fraud cases to appropriate departments

Required Qualifications

Active New York State clinical license

Graduate of a Nursing program; BSN preferred, or a degree in Clinical Psychology or Clinical Social Work

Three years of clinical experience in a healthcare environment; managed care experience is desirable

NYS Driver's License or Identification card required

For Fidelis Care only : NYS RN, OT or PT license required