Texas Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Prior Authorization.

Key Responsibilities

• Analyzes prior authorization requests to determine medical necessity and appropriate level of care
• Coordinates with healthcare providers and interdepartmental teams for timely reviews and authorizations
• Documents and maintains member clinical information to ensure compliance with regulatory guidelines

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• RN license required in Texas
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred