Analyzing prior authorization requests for medical necessity, the full-time New York Licensed Clinical Review Nurse will work remotely during Eastern Time hours, providing recommendations to medical teams and ensuring timely reviews of services. Key responsibilities Perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines Coordinate with healthcare providers and interdepartmental teams to assess and ensure timely care for members Document and maintain member clinical information in health management systems to ensure regulatory compliance Required qualifications Active and unrestricted New York State Registered Nurse (RN) licensure Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience in clinical review or utilization management Knowledge of Medicare and Medicaid regulations preferred Understanding of utilization management processes preferred
New York Licensed Clinical Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.