New York Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Performs medical necessity and clinical reviews of authorization requests to determine appropriateness of care
• Works with healthcare providers and authorization team to ensure timely review of services for members
• Collects, documents, and maintains member's clinical information in health management systems

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• Must have a NYS nursing license
• Knowledge of Medicare and Medicaid regulations preferred
• Clinical knowledge and ability to analyze authorization requests preferred