Pennsylvania 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 to determine appropriateness of care
• Collaborates with healthcare providers and the authorization team to ensure timely review of services
• Collects and maintains member's clinical information in health management systems for compliance

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred
• LPN - Licensed Practical Nurse - State Licensure required