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:
• Reviewing PA requests, opening your auths, reviewing for medical necessity, determining approvals/denials.
• Team meetings may occur; CAMERA ON.
• Some phone time required to call providers for additional info or to inform of denial.
• Target productivity: 18-20 auths/day, 95% monthly productivity expected.

Qualification & Experience:
• Required: LVN/RN
• LVN/RN license MUST BE COMPACT
• 1+ year of authorization/prior auth nursing experience
• Proficient in Microsoft Office, multitasking across 3 screens/systems
• Disqualifiers: job hopping (contract roles excepted), most recent job must be related, illiteracy
• Preferred: Prior auth or managed care experience, work-from-home experience

Top 3 Must-Have Hard Skills (Ranked):

1. Knowledge of Insurance Prior Authorization Processes and consistent policy adherence

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

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

 
 
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: $ 39.00/hr.