Illinois 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 reviews and authorizations 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 preferred Knowledge of Medicare and Medicaid regulations preferred Knowledge of utilization management processes preferred LPN - Licensed Practical Nurse - State Licensure required

Feb 12, 2025 - 13:35

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 reviews and authorizations 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 preferred Knowledge of Medicare and Medicaid regulations preferred Knowledge of utilization management processes preferred LPN - Licensed Practical Nurse - State Licensure required