New York Licensed Clinical Review Nurse

Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025

Job Description:

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 to ensure timely reviews and authorizations
Document and maintain member clinical information in 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
New York State clinical license required
Clinical knowledge to analyze authorization requests preferred
Knowledge of Medicare and Medicaid regulations preferred

Keywords: VirtualVocations, Upland , New York Licensed Clinical Review Nurse, Healthcare , Vista, California

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