California Licensed Care Review RN

Job Summary

A company is looking for a RN- Care Review Clinician specializing in Utilization Review.

Key Responsibilities

• Assess services for members to ensure optimal outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines
• Conduct reviews to determine prior authorization and financial responsibility

Required Qualifications

• At least 2 years of experience in hospital acute care, inpatient review, or managed care
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office suite and applicable software programs
• Experience in utilization review and prior authorization is desirable