Nevada Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Analyzes prior authorization requests to determine medical necessity and appropriate level of care
• Performs medical necessity and clinical reviews of authorization requests in accordance with guidelines and criteria
• Coordinates with healthcare providers and interdepartmental teams to assess medical necessity of care

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• Licensed Practical Nurse (LPN) license required
• RN license required for Health Net of California and Superior Health Plan