A healthcare organization on Long Island is actively seeking a licensed Registered Nurse (RN) to join their team 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
