California Licensed Care Review RN

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

Key Responsibilities

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

Analyze clinical service requests against evidence-based guidelines

Conduct reviews for prior authorization and collaborate with multidisciplinary teams

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 and applicable software programs

Experience in prior authorization or utilization management is preferred