Case Management, Clinical Study Publications, Communication Skills, Electronic Medical Records, Healthcare, Healthcare Providers, Managed Care, Medical Records, Medical Treatment, Nursing, Nursing Credentials, Registered Nurse (RN), Regulatory Compliance, Time Management
A healthcare organization on Long Island, New York is actively seeking a licensed Registered Nurse (RN) to join their team in Nassau County as a Case Manager, focusing on Prior Authorizations.
About the Opportunity:
- Shift: Day
- Schedule: Monday to Friday
- Hours: 8:30am to 5:30pm (1-hour unpaid lunch)
Responsibilities:
- Performing a clinical review of prior authorization requests
- Evaluating medical necessity and appropriateness of care
- Analyzing clinical documentation and medical records
- Communicating with healthcare providers for additional information
- Making authorization decisions in compliance with regulations
Qualifications:
- 2+ years of experience in a Managed Care setting
- Graduate of an accredited School of Nursing
- Active NYS Registered Nurse (RN) license
- Proficiency in medical procedures and evidence-based standards
- Solid understanding of Prior Authorization workflows
- Strong clinical judgment and decision-making skills
- Excellent communication skills
- Organizational and time management skills
- Ability to work independently
Desired Qualifications:
- 2+ years of Managed Care experience
- Bachelor's Degree in Nursing
- Experience with Clinical Criteria Application
- Proficiency in Electronic Medical Record (EMR) systems
T
Tandym
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100 to 499 employees
Staffing/Employment Agencies
http://www.tandymgroup.com