Clinical Review Nurse - Prior Authorization

Lensa - New York, NY

Job Title: Clinical Review Nurse - Prior Authorization

Position: Medical Management/Health Services

Job Type:

Pay: $26.50 - $47.59 per hour

Shift: Day shift Eastern Standard hours

Work Type: Remote, Hybrid, Field, or Office

Address:

City: New York

State: NY

ZIP Code:

Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care.
Provides recommendations to the appropriate medical team to promote quality and cost-effectiveness of medical care.
Performs medical necessity and clinical reviews of authorization requests.
Works with healthcare providers and authorization team to ensure timely review of services.
Coordinates with healthcare providers and interdepartmental teams to assess medical necessity of care.
Escalates prior authorization requests to Medical Directors as appropriate.
Assists with service authorization requests for member’s transfer or discharge plans.
Collects, documents, and maintains all member’s clinical information in health management systems.
Assists with providing education to providers and/or interdepartmental teams on utilization processes.
Provides feedback on opportunities to improve the authorization review process.
Performs other duties as assigned.
Complies with all policies and standards.

Experience: 2 – 4 years of related experience

Education: Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

Centene is an equal opportunity employer that is committed to diversity.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.