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California Licensed Clinical Review Nurse

7/10/2025

California

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