Clinical Review Nurse - Prior Authorization

Location: Remote-NY; active New York RN license required. Monday-Friday, 8:30 AM-5:00 PM ET, with a one-hour lunch break.

Salary: $27.02-$48.55 per hour

Company

hirify.global provides healthcare services focused on improving access to care and health outcomes for individuals, families, and communities.

What you will do

• Review prior authorization requests to determine medical necessity, clinical appropriateness, and the appropriate level of care.
• Coordinate with healthcare providers, authorization teams, and interdepartmental partners to support timely authorized care.
• Escalate complex authorization requests to Medical Directors when appropriate.
• Support transfer and discharge authorization requests across levels of care and facilities.
• Document member clinical information in health management systems and provide education on utilization processes.
• Identify opportunities to improve the authorization review process and promote quality and cost-effective care.

Requirements

• Active New York RN license required.
• BSN or graduation from an accredited school of nursing.
• 2-4 years of related experience.
• Clinical knowledge and ability to analyze authorization requests and determine medical necessity.
• Knowledge of Medicare and Medicaid regulations and utilization management processes is preferred.
• For Fidelis Plan roles, an appropriate clinical healthcare professional license is required.

Culture & Benefits

• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible work approaches, including remote, hybrid, field, and office schedules across the organization.
• Work focused on improving healthcare access and effectiveness.
• Equal opportunity employment and consideration for qualified applicants in accordance with applicable law.