Clinical Review Nurse - Prior Authorization

What this role involves

The role involves reviewing and processing prior authorization requests to ensure medical necessity and compliance with health plan and regulatory requirements. The nurse works within the Utilization Management department, collaborating with providers and Medical Directors. Required qualifications include an active California LVN or RN license and 3-5+ years of clinical UM review experience.

Skills this posting asks for

• lvn
• rn
• clinical utilization management review
• prior authorization
• mcg criteria
• medical necessity review
• managed care
• ezcap
• delegated mso
• health plan environment

Requirements

• 3 years of experience
• Level: mid

From the employer’s posting

Akido builds AI-powered doctors. Akido is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network to address America’s physician shortage and make exceptional healthcare universal. Its AI empowers doctors…