New York Licensed Clinical Review Nurse

Job Summary

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 for timely review of services
• Document and maintain member's clinical information to ensure compliance with regulatory guidelines

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• NYS RN License required
• LPN or RN State Licensure required
• Clinical knowledge in analyzing authorization requests preferred