Texas Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Analyzes prior authorization requests to determine medical necessity and appropriate level of care
• Coordinates with healthcare providers and teams to ensure timely review and authorization of services
• Maintains clinical information in health management systems to ensure compliance with regulatory guidelines

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing
• 2 - 4 years of related experience
• Clinical knowledge to analyze authorization requests for medical necessity
• RN license required; LPN license preferred
• Knowledge of Medicare and Medicaid regulations preferred