California Licensed Prior Authorization Nurse

Job Summary

A company is looking for a UM Prior Authorization Nurse, LVN/LPN (Work from Home).

Key Responsibilities

• Evaluate and process prior authorization requests based on clinical guidelines
• Act as a liaison between healthcare providers, patients, and health plans to facilitate the authorization process
• Accurately document all authorization activities and maintain compliance with regulations

Required Qualifications, Training, and Education

• Associate's degree in Nursing, preferred
• Minimum 2 years of experience in medical management clinical functions
• Active and Unrestricted License as an LVN or LPN for the State of California
• Working knowledge of MCG, InterQual, and NCQA standards
• Certification in Managed Care Nursing (CMCN) preferred