What are the responsibilities and job description for the Prior Authorization RN Case Manager - Hybrid - Free Employee Benefits position at Everly Talent LLC?
Job Overview
A leading healthcare organization is seeking a compassionate and detail-oriented Nurse Case Manager – Prior Authorization RN to join their collaborative team. This is a unique opportunity to bring your clinical expertise to a supportive and mission-driven environment that prioritizes quality care and smart resource utilization.
In this role, you’ll be responsible for reviewing and processing prior authorization requests for medical services to ensure compliance with health plan requirements and evidence-based clinical guidelines. You’ll work closely with providers, patients, and internal departments to support timely and accurate decision-making.
Responsibilities
- Review prior authorization requests for procedures, diagnostics, medications, and other services
- Assess clinical documentation to determine medical necessity
- Communicate with healthcare providers to gather additional information and provide clarification
- Collaborate with internal teams, including utilization and care management
- Document rationale and outcomes of authorization requests accurately and clearly
- Assist in appeals processes and respond to denied authorizations
- Educate providers and members on authorization processes and requirements
- Support continuous improvement of prior authorization workflows
Experience
- Active, unrestricted RN license in New York State (required)
- Bachelor's Degree in Nursing (preferred)
- Minimum 2–3 years of clinical nursing experience
- Experience in utilization management or case management
- Strong knowledge of evidence-based criteria (e.g., MCG, CMS guidelines)
- Excellent communication, documentation, and critical thinking skills
Why Apply?
- Exceptional benefits package, including 100% employer-paid medical and dental coverage for employees
- Hybrid work schedule with 2 days in the office and 3 remote
- Base salary of $90,000–$105,000 annually
- Annual bonus opportunity up to 5% of base salary
- Supportive, inclusive, and mission-driven work culture
- Opportunities for professional growth and advancement
Job Type: Full-time
Pay: $90,000.00 - $105,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
Work Location: Hybrid remote in Garden City, NY 11530
Salary : $90,000 - $105,000
