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 teams to ensure timely review and authorization of services
• Maintains clinical information and provides education on utilization processes to promote quality care

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2-4 years of related experience preferred
• Clinical knowledge to analyze authorization requests and determine medical necessity preferred
• Knowledge of Medicare and Medicaid regulations preferred
• LPN - Licensed Practical Nurse - State Licensure required