Florida Licensed Medical Review Nurse

A company is looking for a Medical Review Nurse (RN).

Key Responsibilities

Review and authorize referral and authorization requests based on established criteria and compliance standards

Assess requests not approved by support staff to determine benefit coverage and medical necessity

Collaborate with Medical Directors on potential denials and case reviews

Required Qualifications

RN license issued by the state (compact license acceptable)

High school diploma or GED

Understanding of Medicare Prior Authorization and CMS rules and regulations