Clinical Review Nurse - Prior Authorization

Position Title : Clinical Review Nurse - Prior Authorization

Work Location : Remote-TX (Sourced nationally - no CA or NY)

Assignment Duration : 1 year (Potential to extend and / or convert to FTE)

Work Schedule : 8AM-5PM their time zone, Monday-Friday, rotating weekends possible voluntary OT

Work Arrangement : Remote

Position Summary :

Reviewing PA requests, opening your auths, reviewing for medical necessity and then determining them.

Background & Context :

• Prior Authorization team for PA requests from non-contracted providers.
• Team consists of 30-32 employees; 3 smaller teams : Redirection, Clinical Review, and Single Case Agreement.
• All work closely together. This position is for the Clinical Review Team.
• Provider facing. Approvals and denials for prior auth.

Key Responsibilities :

Qualification & Experience :

Top 3 Must-Have Hard Skills (Ranked) :

Knowledge of Insurance Prior Authorization Processes and consistent policy adherence

Ability to perform in fast-paced, high-volume environment

Organizational / multitasking skills, computer literacy, ability to work independently