RN Clinical Review Nurse

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