Texas Licensed Care Review Clinician

A company is looking for a Care Review Clinician (RN) for Prior Authorization.

Key Responsibilities

Assess services for members to ensure optimum outcomes and compliance with regulations

Analyze clinical service requests against evidence-based clinical guidelines

Conduct reviews to determine prior authorization and financial responsibility for requested treatments

Required Qualifications

At least 2 years of experience in hospital acute care, inpatient review, or managed care

Active and unrestricted Registered Nurse (RN) license in the state of practice

Ability to prioritize and manage multiple deadlines

Proficiency in Microsoft Office Suite and applicable software programs