New Jersey Licensed Clinical Review Nurse
Job Summary
Conducting clinical reviews and authorizing prior approvals, the New Jersey Licensed Clinical Review Nurse will evaluate medical records, collaborate with healthcare providers, and ensure compliance with regulatory standards, with the possibility of remote work during standard business hours.
Key responsibilities
- Conduct clinical reviews and authorize prior approvals based on healthcare guidelines
- Evaluate medical records and supporting documentation to determine coverage eligibility
- Collaborate with healthcare providers to obtain necessary information and clarify requests
Required qualifications
- Current New Jersey nursing license
- Experience in clinical review or prior authorization processes
- Knowledge of healthcare regulations and compliance standards
- Ability to work during standard business hours with flexibility as needed
- Strong documentation skills for maintaining accurate records
Complete Job Description
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