Job Summary
A company is looking for a Clinical Review Nurse - Prior Authorization.
Key Responsibilities
- Performs medical necessity and clinical reviews of authorization requests
- Coordinates with healthcare providers to ensure timely review of services
- Collects and maintains member's clinical information in health management systems
Required Qualifications, Training, and Education
- Active RN license in Oregon, California, Texas, or Mississippi
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 2 - 4 years of related experience preferred
- Knowledge of Medicare and Medicaid regulations preferred
- Understanding of utilization management processes preferred
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