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