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Prior Authorization RN

RCM Health Care Services -
New York, NY

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Job Details

Full-time
$90,000 - $108,000 a year

Qualifications

Medicare
RN License
Medicaid health insurance
CMS regulatory compliance
Centers for Medicare and Medicaid Services (CMS)
Medicaid regulations
Medicaid
Associate's degree
Associate Degree in Nursing

Full Job Description

Pre-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

About Us
RCM Healthcare Services works with professionals across schools, healthcare, and community-based settings nationwide. We support both contract and direct hire opportunities, connecting people early in their careers and experienced professionals to roles that align with their experience and preferences. With more than 50 years of staffing experience, our team understands the environments you’re stepping into and what it takes to be successful in them. We stay closely involved from first conversation through placement, with consistent communication, a reliable point of contact, and follow-through at every step. We’re committed to caring for the professionals we work with and the communities they support, and offer competitive pay and benefits designed to support your well-being. RCM Healthcare Services is Joint Commission certified, reflecting a commitment to quality, compliance, and a consistent experience.

Equal Employment Opportunity & Reasonable Accommodation
RCM Technologies is an equal opportunity employer and values diversity. We are committed to providing reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADA) and applicable state laws. If you require a reasonable accommodation to apply for or perform this role, please contact us and we will engage in an interactive process to support your needs.

#AC1
#ACP

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