Clinical Review Nurse - LPN
Job Summary
A company is looking for a Clinical Review Nurse - Prior Authorization to analyze prior authorization requests for medical necessity.
Key Responsibilities
- Perform medical necessity and clinical reviews of authorization requests
- Coordinate with healthcare providers and interdepartmental teams for timely reviews
- Assist with service authorization requests for member transfers or discharges
Required Qualifications
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 2 - 4 years of related experience
- Clinical knowledge to analyze authorization requests
- Knowledge of Medicare and Medicaid regulations preferred
- LPN - Licensed Practical Nurse - State Licensure required
COMPLETE JOB DESCRIPTION
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