New York Licensed Clinical Review Nurse

Analyzing prior authorization requests, the full-time New York Licensed Clinical Review Nurse will determine medical necessity and appropriate levels of care while working remotely during Eastern Time hours. Key responsibilities Perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines Collaborate with healthcare providers and authorization teams to ensure timely reviews and appropriate care for members Document and maintain member clinical information in health management systems to ensure compliance with regulations Required qualifications Active and unrestricted New York State Registered Nurse (RN) licensure strongly preferred 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 Familiarity with utilization management processes preferred