Florida Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Analyze prior authorization requests to determine medical necessity and appropriate level of care
• Coordinate with healthcare providers and interdepartmental teams for timely review of services
• Document and maintain member's clinical information in health management systems to ensure compliance

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience in clinical review or prior authorization
• Active Florida LPN or RN license
• Knowledge of Medicare and Medicaid regulations preferred
• Understanding of utilization management processes preferred