Licensed Clinical Review Nurse
Job Summary
A company is looking for a Clinical Review Nurse - Prior Authorization.
Key Responsibilities
- Analyze prior authorization requests to determine medical necessity and appropriate level of care
- Coordinate with healthcare providers and interdepartmental teams to ensure timely reviews of services
- Document and maintain member's clinical information in health management systems for compliance
Required Qualifications, Training, and Education
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 2 - 4 years of related experience
- Knowledge of Medicare and Medicaid regulations preferred
- LPN license or RN license required based on specific health plans
- Clinical knowledge and ability to analyze authorization requests preferred
COMPLETE JOB DESCRIPTION
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