Prior Authorization Nurse — Clinical Review & Utilization (CA)

Akido Labs; Chino (CA); On-site; USD 62,400 - 93,600; Full time

Job summary

Akido Labs is looking for a Clinical Review Nurse in California to manage prior authorization requests. This role ensures compliance with clinical guidelines and coordinates closely with healthcare providers.

The ideal candidate will possess an active California LVN or RN license and have 3-5 years of experience in clinical utilization management. Key responsibilities include reviewing outpatient service authorizations and maintaining accurate documentation using EZCap.

Qualifications

• Active California LVN or RN license required.
• Minimum 3-5 years of clinical UM review experience.
• Familiarity with prior authorization in managed care environments.

Responsibilities

• Review and process prior authorizations for outpatient services.
• Evaluate requests using MCG guidelines and health plan criteria.
• Document all authorization activities accurately within EZCap.

Skills

Clinical assessment skills

Communication skills

Attention to detail

Knowledge of managed care regulations

Education

Active California LVN or RN license

3-5+ years of clinical UM review experience

Tools

EZCap

Job description

Akido Labs is looking for a Clinical Review Nurse in California to manage prior authorization requests. This role ensures compliance with clinical guidelines and coordinates closely with healthcare providers.

The ideal candidate will possess an active California LVN or RN license and have 3-5 years of experience in clinical utilization management. Key responsibilities include reviewing outpatient service authorizations and maintaining accurate documentation using EZCap.