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Full Time Prior Authorization Rn Jobs in New York

Claim Health

Prior Authorization Specialist

New York, NY · On-site

$19.75 - $26.25/hr

Prior authorization is one of the largest operational bottlenecks for agencies. Our platform ... Comfortable working independently in a fast-moving startup Nice to Have * RN, LPN, or clinical ...

Adecco

Registered Nurse

Thornwood, NY

$45 - $47/hr

Six-month contract with opportunity for extension or fulltime offer Hours: Monday - Friday, 8:00AM ... prior authorization · Provide patient education · Documenting care in the EMR while ensuring high ...

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Full Time Prior Authorization Rn information

What is a full time prior authorization RN?

Full Time Prior Authorization Registered Nurses (RNs) are healthcare professionals who work primarily in administrative roles to review and evaluate medical service requests. Their main responsibility is to determine if specific treatments, medications, or procedures meet insurance company criteria for coverage before they are provided to patients. They use their clinical knowledge to assess medical necessity and ensure compliance with healthcare policies and guidelines. These nurses typically interact with physicians, insurance companies, and patients to manage authorizations and appeals, ensuring that care is both appropriate and covered under a patient’s health plan.

What are some typical challenges faced by full time prior authorization RNs, and how can they be managed?

Full Time Prior Authorization RNs often encounter challenges related to navigating complex insurance guidelines, managing high caseloads, and ensuring timely communication between healthcare providers and payers. Staying organized, keeping up-to-date with frequently changing insurance policies, and developing strong collaboration skills with both clinical and administrative teams are key to success in this role. Leveraging electronic health records and standardized workflows can also help streamline the authorization process and reduce delays for patients.

What are the key skills and qualifications needed to thrive as a full time prior authorization RN, and why are they important?

To thrive as a Full Time Prior Authorization RN, you need a strong nursing background (active RN license), in-depth knowledge of medical terminology, and experience with insurance processes or utilization review. Familiarity with prior authorization software, electronic health records (EHRs), and insurance payer portals is typically required. Exceptional attention to detail, critical thinking, and strong communication skills help you effectively evaluate medical necessity and advocate for patient care. These abilities ensure timely, accurate authorizations, reduce claim denials, and promote optimal patient outcomes.

What is the difference between Full Time Prior Authorization Rn vs Medical Coder?

AspectFull Time Prior Authorization RnMedical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), knowledge of medical coding systems
Work EnvironmentHealthcare facilities, insurance companies, utilization review departmentsMedical offices, hospitals, insurance companies, coding agencies
Job FocusReviewing and authorizing medical procedures and treatmentsTranslating medical records into standardized codes for billing

While both roles require healthcare knowledge, the Full Time Prior Authorization RN focuses on evaluating medical necessity for treatments, whereas Medical Coders translate medical documentation into codes for billing. Both are essential in healthcare administration but serve different functions within the patient care and billing process.

What are the most commonly searched types of Prior Authorization Rn jobs in New York?

The most popular types of Prior Authorization Rn jobs in New York are:

What cities in New York are hiring for Full Time Prior Authorization Rn jobs?

Cities in New York with the most Full Time Prior Authorization Rn job openings:

Full Time Prior Authorization Rn jobs near you

Nurse Case Manager, Prior Authorization RN

HealthCare Partners, MSO

Garden City, NY

Full-time

Medical, Dental, Retirement, PTO

Re-posted 29 days ago

Job description

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care.  Interested in joining our successful Garden City Team?  We are currently seeking a Nurse Case Manager, Prior Authorization RN!  
Position Summary: The Nurse Case Manager, Prior Authorization RN is responsible for reviewing and processing prior authorization requests for medical services, ensuring that all clinical criteria and health plan requirements are met. This role reports to the Manager of Inpatient Utilization Management and involves collaborating with healthcare providers, patients, and internal teams to determine the medical necessity of requested services, ensuring compliance with insurance guidelines, and maintaining accurate documentation. The Nurse Case Manager, Prior Authorization RN will support the goal of delivering timely and efficient authorization decisions while promoting quality patient care.
Essential Position Functions/Responsibilities:
  • Review incoming prior authorization requests for medical services, including procedures, medications, and diagnostic tests, ensuring that they meet clinical guidelines and health plan requirements.
  • Evaluate medical records, clinical documentation, and provider notes to determine the medical necessity and appropriateness of requested services based on established criteria.
  • Communicate with healthcare providers, including physicians and specialists, to obtain additional information or clarification needed to process prior authorization requests.
  • Work closely with other teams, such as utilization management, care management, and pharmacy, to ensure accurate and timely processing of prior authorization requests.
  • Ensure all prior authorization processes comply with relevant healthcare regulations, health plan policies, and turnaround time standards.
  • Accurately document the review process, decisions, rationale, and outcomes of prior authorization requests, maintaining clear and comprehensive records in the system.
  • Support the review and resolution of denied prior authorization requests, including assisting with the preparation of information for appeals, when necessary.
  • Educate healthcare providers and patients on the prior authorization process, required documentation, and health plan requirements.
  • Assist in identifying opportunities for process improvements in the prior authorization workflow to increase efficiency and reduce errors.
  • Ensure that prior authorization requests are processed within designated time frames to meet regulatory and health plan requirements.

Qualification Requirements:
Skills/Knowledge/Abilities
  • Strong understanding of clinical procedures, diagnoses, and treatments, with the ability to assess medical necessity based on evidence-based guidelines (MCG, National Coverage Determinations and Local Coverage Determinations).
  • Excellent written and verbal communication skills, particularly in interacting with healthcare providers and patients in a professional and clear manner.
  • Ability to manage multiple requests simultaneously while maintaining a high level of accuracy and efficiency.
  • Strong critical thinking and decision-making skills to evaluate requests and address issues related to medical necessity and health plan compliance.
  • Understanding of the prior authorization process, including guidelines, clinical review criteria, regulatory requirements and turnaround time expectations.
  • Ability to adapt to changing health plan requirements, clinical criteria, and workflow processes.

Training/Education:
  • Registered Nurse (RN) with an active and unrestricted nursing license in the state of practice required; Bachelor’s degree in Nursing (preferred).

Experience:
  • At least 2-3 years of clinical nursing experience, with at least 1 year in utilization management, prior authorization, or a related healthcare setting.
  • Experience in reviewing medical records, clinical documentation, and prior authorization requests.
  • Familiarity with clinical decision-making criteria and evidence-based guidelines used in the prior authorization process (preferred).

Our website: HealthCare Partners
Base Compensation: $90,000 – 105,000 annually
Bonus Incentive: Eligibility based off organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)
Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.
 

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