Clinical Review Nurse - LPN - Raleigh North Carolina

Company: VirtualVocations
Location: Raleigh, North Carolina
Posted On: 09/18/2024

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


Required Qualifications

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience in clinical review or medical management
Knowledge of Medicare and Medicaid regulations preferred
LPN - Licensed Practical Nurse - State Licensure required
Experience in utilization management processes preferred More...

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