Oregon Licensed Clinical Review Nurse

Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025

Job Description:

A company is looking for a Clinical Review Nurse - Prior Authorization.
Key Responsibilities

Analyzes prior authorization requests to determine medical necessity and appropriate level of care
Collaborates with healthcare providers and authorization teams to ensure timely service reviews
Maintains member clinical information in health management systems to ensure compliance with regulatory guidelines

Required Qualifications

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

Keywords: VirtualVocations, Lake Forest , Oregon Licensed Clinical Review Nurse, Healthcare , Vista, California

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