LPN 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 to ensure timely review of services
• Document and maintain member's clinical information in health management systems for compliance

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience in clinical settings
• LPN - Licensed Practical Nurse - State Licensure required
• Preferred knowledge of Medicare and Medicaid regulations
• Preferred knowledge of utilization management processes