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
Provides recommendations to medical teams to promote quality and cost-effective care
Documents and maintains members' clinical information in health management systems for compliance
Required Qualifications
Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2-4 years of related experience preferred
Licensed Practical Nurse (LPN) - State Licensure required
RN license required for specific locations
Clinical Review Nurse • Oxnard, California, United States