Position Title: Clinical Review Nurse – Prior Authorization

Work Location: Fully Remote, TX (Central Time Zone preferred)

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: 10AM–7PM CST (1-hour lunch)

Work Arrangement: Remote

Position Summary:
Purpose is to perform prior authorization clinical reviews for Texas Marketplace members.
Role also supports non-PAR (out-of-network) redirections.

Background & Context:
Team of 21 prior authorization nurses supporting Texas Marketplace expansion.
Collaboration and team-based training environment.

Key Responsibilities:

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

• Route cases to MD review when required

• Assist with out-of-network requests and redirect to in-network providers as needed

• Complete a minimum of 20 clinical reviews per day

• Perform 2 redirections per hour when assigned to non-PAR work

  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: $ 39.00/hr.