Licensed Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Prior Authorization. Key Responsibilities Analyzes prior authorization requests to determine medical necessity and appropriate level of care Coordinates with healthcare providers and teams to ensure timely review and authorization of services Maintains clinical information and provides education on utilization processes to promote quality care Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2-4 years of related experience preferred Clinical knowledge to analyze authorization requests and determine medical necessity preferred Knowledge of Medicare and Medicaid regulations preferred LPN - Licensed Practical Nurse - State Licensure required

May 19, 2025 - 16:50

A company is looking for a Clinical Review Nurse - Prior Authorization. Key Responsibilities Analyzes prior authorization requests to determine medical necessity and appropriate level of care Coordinates with healthcare providers and teams to ensure timely review and authorization of services Maintains clinical information and provides education on utilization processes to promote quality care Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2-4 years of related experience preferred Clinical knowledge to analyze authorization requests and determine medical necessity preferred Knowledge of Medicare and Medicaid regulations preferred LPN - Licensed Practical Nurse - State Licensure required