Clinical Review Nurse - Louisiana - Boulder Colorado

Company: VirtualVocations
Location: Boulder, Colorado
Posted On: 11/17/2024

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 interdepartmental teams to ensure timely reviews and authorizations
Document and maintain member clinical information to ensure compliance with regulatory guidelines



Required Qualifications, Training, and Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience
RN/LPN/LVN Licensure in Louisiana or a Compact License required
Knowledge of Medicare and Medicaid regulations preferred
Understanding of utilization management processes preferred More...

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