Clinical Review RN - Prior Authorization (Remote/Onsite)

Medix™; Rhode Island; Hybrid; USD 85,000 - 110,000; Full time

Job summary

Medix is seeking a Clinical Review RN for Prior Authorization, with 2 years of acute care experience and 1 year in prior authorization. The role supports Rhode Island utilization reviews and may require RI licensure or RI licensure readiness if based in NY.

The position involves reviewing inpatient cases, documenting medical necessity, and coordinating with physicians and analysts to ensure accurate authorizations. Onsite in Jericho or remote in RI is possible.

Qualifications

• Two years of acute clinical experience required.
• One to three years in acute care utilization review and prior authorization processes.

Responsibilities

• Conduct utilization reviews up to the appeal level for inpatient cases.
• Review admission screening across medical, surgical, psychiatric charts.
• Process authorizations, discharges, and waivers; perform concurrent/retrospective reviews.
• Collect data for clinical study objectives and collaborate with team members.
• Maintain knowledge of Medicaid payer guidelines and EMR systems.
• Provide training support and assist staff with procedures.

Skills

Acute care nursing

Utilization review

Prior authorization

Communication skills

Independent work

Education

Bachelor's degree in Nursing

Tools

EMR systems

Job description

Medix is seeking a Clinical Review RN for Prior Authorization, with 2 years of acute care experience and 1 year in prior authorization. The role supports Rhode Island utilization reviews and may require RI licensure or RI licensure readiness if based in NY.

The position involves reviewing inpatient cases, documenting medical necessity, and coordinating with physicians and analysts to ensure accurate authorizations. Onsite in Jericho or remote in RI is possible.