Wisconsin Licensed Clinical Review Nurse
- Full-time
A company is looking for a Clinical Review Nurse - Prior Authorization.
Key Responsibilities
Analyze prior authorization requests to determine medical necessity and appropriate level of care
Coordinate with healthcare providers and internal teams to ensure timely review of services
Document and maintain member's clinical information in health management systems for compliance
Required Qualifications, Training, and Education
Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience
LPN - Licensed Practical Nurse - State Licensure required
Clinical knowledge and ability to analyze authorization requests preferred
Knowledge of Medicare and Medicaid regulations preferred
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Clinical Review Nurse • Springfield, Massachusetts, United States