Arizona Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Prior Authorization to support their Duals team.

Key Responsibilities

• Conducts medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines
• Collaborates with healthcare providers and authorization teams to ensure timely review and authorization of services
• Maintains member clinical information in health management systems to ensure compliance with regulatory guidelines

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience in clinical review or authorization processes
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred
• LPN - Licensed Practical Nurse - State Licensure required