Florida Licensed Clinical Review Nurse - Portland Maine

Company: VirtualVocations
Location: Portland, Maine
Posted On: 01/25/2025

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 review and authorization of services
Document and maintain member clinical information in health management systems to ensure regulatory compliance


Required Qualifications, Training, and Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience in nursing
Current LPN or RN license required based on state regulations
Clinical knowledge with the ability to analyze authorization requests
Knowledge of Medicare and Medicaid regulations preferred More...

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