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

• Evaluate prior authorization requests for medical necessity and compliance with standards and member benefits
• Collaborate with the medical team to provide recommendations on complex authorization requests
• Promote quality and cost-effective medical care while ensuring adherence to policies and regulations

Required qualifications

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