RN Prior Authorization Case Manager

Health Care Partners; Village of Garden City (NY); On-site; USD 90,000 - 105,000; Full time

Benefits offered by this job

Medical & Dental coverage

PTO

401k

FSA

Tuition Reimbursement

Job summary

HealthCare Partners, MSO in Garden City, NY is seeking a Nurse Case Manager, Prior Authorization RN to review and process prior authorization requests, ensure clinical criteria and health plan requirements are met, and collaborate with providers, patients, and internal teams.

The role requires an RN license in NY, 2–3 years of nursing experience with utilization management or prior authorization, and strong communication, documentation, and regulatory knowledge.

Qualifications

• RN with active and unrestricted nursing license in the state of practice.
• Bachelor’s degree in Nursing preferred.

Responsibilities

• Review and process prior authorization requests for medical services.
• Evaluate medical records to determine medical necessity per criteria.
• Communicate with physicians, providers and staff for required information.
• Document review decisions and maintain accurate records in the system.
• Support appeals and educate providers/patients on prior authorization requirements.

Skills

Clinical knowledge

Communication

Multitasking

Decision making

Regulatory compliance

Adaptability

Education

RN license in state of practice

BSN preferred

Job description

HealthCare Partners, MSO in Garden City, NY is seeking a Nurse Case Manager, Prior Authorization RN to review and process prior authorization requests, ensure clinical criteria and health plan requirements are met, and collaborate with providers, patients, and internal teams.

The role requires an RN license in NY, 2–3 years of nursing experience with utilization management or prior authorization, and strong communication, documentation, and regulatory knowledge.