Missouri Licensed Clinical Review Nurse

Job Summary

Analyzing prior authorization requests to determine medical necessity and appropriate levels of care, the full-time Missouri Licensed Clinical Review Nurse will work remotely, collaborating with healthcare providers and teams to ensure timely and effective medical care for foster care members.

Key responsibilities

• Conducts medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines
• Collaborates with healthcare providers and authorization teams to ensure timely service reviews for members
• Maintains clinical information in health management systems to ensure compliance with regulatory standards

Required qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience, preferably in prior authorization
• Knowledge of Medicare and Medicaid regulations is preferred
• Understanding of utilization management processes is preferred
• Current RN licensure in Missouri is required