California Licensed Prior Authorization Nurse

Company: VirtualVocations
Location: Vista
Posted on: May 24, 2025

Job Description:

A company is looking for a UM Prior Authorization Nurse, RN (Work from home).
Key Responsibilities

Evaluate and process prior authorization requests based on clinical guidelines and assess medical necessity
Act as a liaison between healthcare providers, patients, and health plans, communicating authorization decisions and compliance requirements
Document authorization activities accurately and identify trends for quality improvement in the authorization process

Required Qualifications

Licensed Registered Nurse (RN) with an active, unrestricted California nursing license
Minimum of 2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management
Experience in a managed care setting with medical necessity reviews is preferred
Preferred certifications include Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), or Accredited Case Manager (ACM)
Additional clinical nursing or case management certifications are a plus

Keywords: VirtualVocations, Rancho Santa Margarita , California Licensed Prior Authorization Nurse, Healthcare , Vista, California