MA/NH Licensed Prior Authorization Nurse
Company: VirtualVocations
Location: Portland
Posted on: April 22, 2025
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Job Description:
A company is looking for a Prior Authorization Medical
Clinician.
Key Responsibilities:
Review and determine medical necessity of inpatient and outpatient
services using evidence-based guidelines
Perform utilization review activities, including pre-certification
and concurrent reviews
Document and communicate all utilization review activities and
outcomes effectively
Required Qualifications, Training, and Education:
Nursing degree or diploma required; bachelor's degree in nursing
preferred
Active, unrestricted RN license in state of residence
2+ years of prior authorization experience and knowledge of
evidence-based guidelines
Managed care experience
Knowledge of Medicare and Medicaid is desirable
Keywords: VirtualVocations, New England , MA/NH Licensed Prior Authorization Nurse, Healthcare , Portland, Northeast
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