Florida Licensed Clinical Review Nurse

Job Summary

Analyzing prior authorization requests for medical necessity, the full-time Florida Licensed Clinical Review Nurse will work remotely to ensure appropriate levels of care in accordance with national standards, while also providing recommendations to the medical team and coordinating with healthcare providers.

Key responsibilities

• Perform medical necessity and clinical reviews of authorization requests in line with regulatory guidelines
• Coordinate with healthcare providers and interdepartmental teams to ensure timely reviews of services and requests
• Assist with service authorization requests for member transfers or discharge plans to ensure timely transitions between care levels

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
• Licensed Practical Nurse (LPN) certification required; Registered Nurse (RN) licensure preferred
• Knowledge of Medicare and Medicaid regulations preferred
• Experience in hospice and managed care environments preferred