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RN Clinical Review Nurse

7/11/2025

N/A

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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