Florida Licensed Medical Review Nurse

Job Summary

A company is looking for a Medical Review Nurse (RN).

Key Responsibilities

• Review and authorize referral and authorization requests based on established criteria and compliance standards
• Assess requests not approved by support staff to determine benefit coverage and medical necessity
• Collaborate with Medical Directors on potential denials and case reviews

Required Qualifications

• RN license issued by the state (compact license acceptable)
• High school diploma or GED
• Understanding of Medicare Prior Authorization and CMS rules and regulations