Clinical Review Nurse - Prior Authorization

Akido
Chino, California, United States
Full Time
On Site
Senior
USD 62,400 – 93,600
Professional Certificate
Healthcare Healthcare Life Sciences

Posted 2 days ago

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Excellent 4.7

Job summary

The Clinical Review Nurse – Prior Authorization reviews and processes prior authorization requests to ensure medical necessity, compliance, and appropriate care within a managed care environment, requiring active California RN or LVN license and 3-5+ years of related experience.

Responsibilities

Review and process prior authorization requests for outpatient services to ensure medical necessity and compliance with health plan requirements. Collaborate with providers and Medical Directors to document clinical determinations and maintain regulatory standards.

Qualifications

Clinical assessment Clinical review Communication skills Healthcare regulations Medical documentation Medical necessity Prior authorization

Requires an active California LVN or RN license and 3-5+ years of clinical utilization management experience. Proficiency with MCG criteria and experience in a managed care or delegated MSO environment is required or preferred.

English

Company

Akido

Akido

Location
Chino, California, United States

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Excellent 4.7
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