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 teams to ensure timely review and authorization of services
- Maintains clinical information in health management systems 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
- California State RN license required
- Knowledge of Medicare and Medicaid regulations preferred
- Knowledge of utilization management processes preferred