Texas Licensed Clinical Review Nurse

Job Summary

Reviewing prior authorization requests, the remote Texas Licensed Clinical Review Nurse will assess medical necessity and provide recommendations to the medical team while working Monday through Friday with rotational weekends and holidays.

Key responsibilities

• Review prior authorization requests to determine medical necessity and appropriateness of care
• Assess complex authorization requests and collaborate with the medical team for recommendations
• Promote quality medical care and ensure compliance with policies and state regulations

Required qualifications

• Graduate from an accredited school of nursing or hold a Bachelor's degree in Nursing
• Current RN or LPN state licensure required; NV or Compact RN license preferred
• Prior authorization or preservice experience in a Utilization Management department
• Experience with InterQual or Milliman guidelines
• Must be authorized to work in the United States without employment-based visa sponsorship