Position Title: Clinical Review Nurse - Prior Authorization
Work Location: Fully Remote, TX central time zone preferred
Assignment Duration: 3 Months with a potential of extension or conversion
Work Schedule: Shift 10 AM-7 PM CST - 1 hour lunch, weekends
Training – 4-5 weeks 8 AM – 5 PM CST (No days off) CAMERA ON

Position Summary: 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.

Background & Context: Purpose: to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections. Team currently consists of 21 prior authorization nurses performing this work, it is a team effort, collaboration with team members is available to answer any questions and training will be handled at the team level.

Key Responsibilities:

• Performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed.
• Assist with out of network requests and redirecting to in network providers as needed.

Qualification & Experience:

Candidate Requirements
Education/Certification	Required: 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:			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: $ 36.00/hr.