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 clinical information in health management systems for compliance with regulatory guidelines

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• California State RN license required
• Clinical knowledge and ability to analyze authorization requests preferred
• Knowledge of Medicare and Medicaid regulations preferred