Job DescriptionPre-Authorization RN Compensation Salary Range: $90,000 - $108,000 per year
Bonus / Commission (if applicable): This role is eligible for a $15,000 sign-on bonus.
Location: Lower Manhattan, NY (Training) / Remote
Hybrid training transitioning to Remote
Position Summary As a Pre-Authorization RN, you will support care coordination by reviewing and processing authorization requests in alignment with regulatory and organizational guidelines. This role involves collaboration with interdisciplinary teams to ensure timely and appropriate care delivery. Following a structured hybrid training period, this position transitions to a fully remote setting while maintaining high standards of clinical accuracy and compliance.
Responsibilities ? Schedule / Shift - Shift details: Monday - Friday (Business Hours)
- Hours per week: 40
? Key Duties: - Review and process authorization requests in accordance with Medicare, Medicaid, and internal guidelines
- Collaborate with care managers, nurses, and providers to ensure timely and appropriate service delivery
- Coordinate completion of UAS-NY assessments to reflect members' current clinical status
- Ensure care plans are accurate, updated, and aligned with member needs
- Maintain accurate documentation and support compliance with utilization management standards
Requirements ? Education - Required: Associate's Degree in Nursing
- Preferred (if applicable): Bachelor's Degree in Nursing (BSN)
? Licenses & Certifications - Required: Active New York State Registered Nurse (RN) license
- Additional certifications (if applicable): CCM certification preferred
? Skills: - Strong knowledge of Medicare and Medicaid regulations
- Experience in prior authorization or utilization review processes
- Excellent clinical judgment, assessment, and decision-making skills
- Proficiency in Microsoft Office (Word, Excel) and familiarity with InterQual preferred
