Clinical Review Nurse - Prior AuthorizationSpectraforce Technologies • Raleigh, NC, United States
Clinical Review Nurse - Prior Authorization
Spectraforce Technologies • Raleigh, NC, United States
30+ days ago
Job type
- Full-time
Job descriptionPurpose : to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed. Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out of network requests will perform 2 redirections per hour This role is unique as it supports Marketplace expansion for Texas Required : ADN, BSN - Requires a Graduate from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 - 4 years of related experience. Required : RN Disqualifiers : LVN Additional qualities to look for : True care experience Top 3 must-have hard skills stack-ranked by importance Top 3 must-have hard skills stack-ranked by importance
Position Title : Clinical Review Nurse - Prior Authorisation
Work Location : Fully Remote, TX
Assignment Duration : 3 months (Potential to extend and / or convert )
Work Schedule : Training - 4-5 weeks 8 AM - 5 PM CST (No days off) CAMERA ON
- ? Shift 10 AM-7 PM CST - 1 hour lunch
Work Arrangement : Fully Remote, TX (central time zone preferred)
Position Summary :
Key Responsibilities :
Qualification & Experience :
1 Adaptable to change
2 quick processing, critical thinking
3 well-organised
Candidate Requirements
Education / Certification
Required : ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience
Preferred : Licensure
Required : RN
Preferred : Licensure
Disqualifiers : LVN
Additional qualities to look for : True care experience
Adaptable to change
quick processing, critical thinking
well organized
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Authorization Review • Raleigh, NC, United States
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