Missouri Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Conducts medical necessity and clinical reviews of authorization requests
• Collaborates with healthcare providers and authorization teams for timely service reviews
• Documents and maintains member clinical information in compliance with regulatory guidelines

Required Qualifications, Training, and Education

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