California Licensed Clinical Review Nurse

Job Summary

A company is looking for a 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 and authorization of services
• Document and maintain member's clinical information in health management systems for compliance with regulatory guidelines

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience preferred
• California State RN license required
• Knowledge of Medicare and Medicaid regulations preferred
• Familiarity with utilization management processes preferred