New York Licensed RN Review Nurse

Analyzing prior authorization requests for medical necessity, the full-time New York Licensed RN Review Nurse will perform clinical reviews, collaborate with healthcare providers for timely service authorization, and maintain compliance with regulatory guidelines in a remote setting. 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 authorization of care Document and maintain member clinical information in health management systems to ensure compliance with regulations Required qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience in clinical review or authorization processes Clinical knowledge to analyze authorization requests and determine medical necessity Knowledge of Medicare and Medicaid regulations preferred Current New York RN license required