State 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 interdepartmental teams to ensure timely reviews of services Document and maintain member clinical information in health management systems for compliance Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience RN, LVN, or LPN State Licensure required Clinical knowledge and ability to analyze authorization requests preferred Knowledge of Medicare and Medicaid regulations preferred

Mar 25, 2025 - 19:54

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 interdepartmental teams to ensure timely reviews of services Document and maintain member clinical information in health management systems for compliance Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience RN, LVN, or LPN State Licensure required Clinical knowledge and ability to analyze authorization requests preferred Knowledge of Medicare and Medicaid regulations preferred