Title: Registered Nurse
Location: 100% Remote
Shift/Hours: Monday - Friday, 9:00 AM – 5:30 AM EST (30-minute unpaid lunch)
Training Hours: Same as shift hours
Start/End Dates:

• Start Date: 07/14/2025
• End Date: 08/29/2025

Job Description

Duties

• No direct patient care. This is a virtual position.
• Responsible for clinical criteria prior authorization setup based on client clinical policy requirements, creating prior authorization requests sent to prescribers.
• Questions created may include:
  • Is the patient 18?
  • Does the patient have
  • Has the patient tried and failed alternative medications?
• Responsible for creating/coding denial rationales sent to prescribers and patients using a proprietary web-based ESI platform (training provided).
• Strong Microsoft Office skills required, particularly in Excel.
• Configuration support will cover both pharmacy and medical criteria.
• Requires creative problem-solving skills for effective setup and operational efficiency.
• May provide consultative support to internal ESI business partners regarding criteria setup and system requirements.
• Strong and effective communication skills are highly desired.

 

Skills

• Communication
• Microsoft Office
• Organization
• Self-Driven
• Collaboration

Qualifications:

1. Demonstrates 'Team Player' and collaborative skills within internal and external teams
2. Thinks strategically about domain-related problems and challenges
3. Communicates effectively within peer and subordinate groups
4. Accountable for designated client relationships and related service requests
5. Develops robust operational controls to maximize service levels
6. Identifies clinical system or process change needs to enhance service levels
7. Understands and articulates the importance of responsibilities and controls
8. Mitigates concerns of business partners within scope
9. Clearly communicates with clients when providing consultative services

3 Non-Negotiable Skills

• Licensed RN
• Good communication
• Attention to detail

Education

• Requires an RN license in good standing, as required by the state in which work is performed

 

 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $30.00/hr.