Clinical Review Nurse - Complex Case Management and Prior-Authorization

Onsite Chino, California

operations

greenhouse

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Job description

You will review prior authorization requests and support complex case management for high-risk patients in Chino, California. This role involves collaboration with healthcare providers to ensure compliance and timely decisions.

Details

Chino, California, work from office
$78,000—$103,000 USD
3-5+ years of current clinical UM review
Active California RN license required

The work

Review and process prior authorizations for various services
Evaluate requests using MCG guidelines and health plan criteria
Lead interdisciplinary care management for high-risk populations
Document all authorization activities accurately within EZCap