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 interdepartmental teams to ensure timely review and authorization of services

Document and maintain member's clinical information in health management systems for 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

Licensed Practical Nurse (LPN) State Licensure required; Registered Nurse (RN) State Licensure preferred

Clinical knowledge and ability to analyze authorization requests preferred

Knowledge of Medicare and Medicaid regulations and utilization management processes preferred