Illinois Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Prior Authorization.

Key Responsibilities

• Analyzes prior authorization requests to determine medical necessity and appropriate level of care
• Coordinates with healthcare providers and internal teams to ensure timely reviews and authorizations
• Documents and maintains clinical information in health management systems for compliance with regulations

Required Qualifications

• Active, current Illinois LPN or RN licensure
• Graduate from an accredited school of nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience preferred
• Knowledge of Medicare and Medicaid regulations preferred
• Understanding of utilization management processes preferred