Description. . Review, recommend and provide authorization for service requests. Process requests from in-network providers. Suggest alternative care plans for patients that meet their coverage and finical needs. Document case reviews. Present cases to Medical Director and Physicians for review. Perform other job duties as needed. . Skills. . Clinical review, Rn license, BSN, Case management, Health informatics. . Top Skills Details. . Clinical r...
Join our team as a Clinical Review Nurse. Compensation. $58–$65 per hour (based on experience). Benefits. Comprehensive medical benefits and retirement plan. Location. Uniondale, NY (Hybrid Role). Hours. Monday-Friday 8 : 30 AM-5 : 30 PM. Long Term Contract Position. Are you ready to bring your expertise as a Registered Nurse to the forefront of quality improvement and performance excellence. This is your opportunity to make a meaningful impact w...
Description. Reviewing authorization requests. Utilizing evidence-based criteria and making a medically necessary determination. Outreach calls to providers to request additional details if applicable. They will not be completing any calls to members. Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's bene...
Job Title: PAC Nurse. Job Description. The PAC Nurse is a telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned and non-assigned post-acute care (PAC) facilities through collaboration. The PAC Nurse will collaborate with key facility per...
