California Licensed Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Prior Authorization (RN). Key Responsibilities Analyze prior authorization requests to determine medical necessity and appropriate level of care Coordinate with healthcare providers and interdepartmental teams to ensure timely reviews and authorizations Document and maintain member clinical information in compliance with regulatory guidelines Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience RN license required for Health Net of California Clinical knowledge and ability to analyze authorization requests preferred Knowledge of Medicare and Medicaid regulations preferred

Feb 12, 2025 - 13:33

A company is looking for a Clinical Review Nurse - Prior Authorization (RN). Key Responsibilities Analyze prior authorization requests to determine medical necessity and appropriate level of care Coordinate with healthcare providers and interdepartmental teams to ensure timely reviews and authorizations Document and maintain member clinical information in compliance with regulatory guidelines Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience RN license required for Health Net of California Clinical knowledge and ability to analyze authorization requests preferred Knowledge of Medicare and Medicaid regulations preferred