Florida Licensed Clinical Review Nurse

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

Feb 19, 2025 - 12:55

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