Wisconsin Licensed Clinical Review Nurse

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