Clinical Review Nurse - Complex Case Management and Prior-Authorization

The Clinical Review Nurse will primarily focus on reviewing and processing prior authorization requests to ensure they meet medical necessity and compliance standards. This role also involves supporting complex case management for high-risk members, collaborating with healthcare providers, and maintaining accurate documentation of clinical determinations and care plans.

• Salary range provided is $62,400 — $93,600 USD
• Role is primarily focused on prior authorization review with secondary responsibilities in case management, which may limit exposure to broader clinical practices
• Experience with EZCap is preferred but not required, which could impact onboarding for those unfamiliar with the system