Position Title: Clinical Review Nurse – Prior Authorization
Work Location: Fully Remote, TX – Central Time Zone preferred
Assignment Duration: 3 months
Work Schedule: Shift 10 AM–7 PM CST – 1 hour lunch

Position Summary:

• Perform prior authorization clinical reviews for Texas Marketplace members

• Assist with non-par (out-of-network) redirections

Background & Context:

• Team of 21 nurses performing prior auth reviews

• 10 temps being hired across 2 shifts

• Team culture: collaborative, supportive

• Training handled at team level

Key Responsibilities:

• Perform clinical reviews for prior authorization requests using policies and InterQual

• Refer to MD if needed

• Handle out-of-network requests

• Redirect members to in-network providers

• Complete 20+ reviews/day

• Complete 2 redirections/hour if assigned

Qualification & Experience:

• Graduate from Accredited School of Nursing or BSN

• RN license (Compact or Texas) required

• 2–4 years of related clinical experience

• Disqualifier: LVN

• Must be organized, adaptable, critical thinker

• Training 4–5 weeks, 8AM–5PM CST, camera on

 

 


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: $35.00/hr.