Oklahoma Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Conduct clinical reviews for medical necessity and appropriateness of care
• Collaborate with healthcare providers and interdepartmental teams for timely service reviews
• Document and maintain member clinical information in health management systems

Required Qualifications, Training, and Education

• 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
• Knowledge of Medicare and Medicaid regulations preferred
• Licensed Practical Nurse (LPN) State Licensure required