Florida 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 reviews and authorized care
• Document and maintain member clinical information to ensure 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
• Active Florida LPN or RN license required
• Knowledge of Medicare and Medicaid regulations preferred
• Understanding of utilization management processes preferred