MA/NH Licensed Prior Authorization Nurse

A company is looking for a Prior Authorization Medical Clinician. Key Responsibilities: Review and determine medical necessity of inpatient and outpatient services using evidence-based guidelines Perform utilization review activities, including pre-certification and concurrent reviews Document and communicate all utilization review activities and outcomes effectively Required Qualifications, Training, and Education: Nursing degree or diploma required; bachelor's degree in nursing preferred Active, unrestricted RN license in state of residence 2+ years of prior authorization experience and knowledge of evidence-based guidelines Managed care experience Knowledge of Medicare and Medicaid is desirable

Apr 4, 2025 - 10:30

A company is looking for a Prior Authorization Medical Clinician. Key Responsibilities: Review and determine medical necessity of inpatient and outpatient services using evidence-based guidelines Perform utilization review activities, including pre-certification and concurrent reviews Document and communicate all utilization review activities and outcomes effectively Required Qualifications, Training, and Education: Nursing degree or diploma required; bachelor's degree in nursing preferred Active, unrestricted RN license in state of residence 2+ years of prior authorization experience and knowledge of evidence-based guidelines Managed care experience Knowledge of Medicare and Medicaid is desirable