Position Title: Clinical Review Nurse – Prior Authorization
Work Location: Fully Remote, TX (central time zone preferred; must have compact state licensure and/or Texas licensure)
Assignment Duration: 3 months Potential to extend and/or convert if position opens
Work Schedule: Training – 4–5 weeks, 8AM – 5PM CST (No days off) CAMERA ON; Shift 10 AM–7PM CST – 1 hour lunch
Work Arrangement: Remote

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Position Summary:

Perform prior authorization clinical reviews for Texas Marketplace members, and assist with non-par (out of network) redirections. Training will be handled at the team level and collaboration with team members is available to answer questions.

Background & Context:

The team consists of prior authorization nurses supporting Marketplace expansion for Texas. A total of 10 temporary workers will be hired across two schedules.

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Key Responsibilities:

• 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.

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Qualification & Experience:

• Required: ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience
• Licensure Required: RN
• Years of experience required: 2-4 years
• Disqualifiers: LVN
• Additional qualities to look for: True care experience
• Top 3 must-have hard skills stack-ranked by importance
1 Adaptable to change
2 quick processing, critical thinking
3 well organized

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:
Years of experience required: 2-4 years   Disqualifiers: LVN   Additional qualities to look for: True care experience
Top 3 must-have hard skills stack-ranked by importance		1	Adaptable to change
		2	quick processing, critical thinking
		3	well organized

 
 
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: $ 37.00/hr.