Job Description
Position Title: Clinical Review Nurse – Prior Authorization
Work Location: Remote – Texas
Assignment Duration: 03 Months Possibility to extend or convert
Work Schedule:
Schedule may vary: Training will be 8am-5pm Monday through Friday. Once training is completed, the scheduled will either be Tuesday- Saturday- 10a-7pm Tuesday -Saturday or Sunday- Thursday 10a-7pm. Manager will review schedules in the interview as well.
Work Arrangement: Remote
Position Summary:
Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Key Responsibilities:
• Filtering assignments, processing prior authorizations for Texas Ambetter to maintain compliance and turn around time.
| Candidate Requirements | ||||
| Required: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. | Preferred: BSN preferred, ADN accepted | |||
| Required: RN License | Preferred: | |||
| Years of experience required: 2-4 years prior authorization experience from the insurance side. Disqualifiers: Additional qualities to look for: Knowledge with TruCare and/or Interqual (IQ) | ||||
| 1 | Proficiently navigating all required programs, systems, and computer applications | ||
| 2 | The ability to work efficiently and accurately in a fast?paced environment | |||
| 3 | Being a team player who can adapt well to change | |||
- For information on benefits, equal opportunity employment, and location-specific applicant notices, click here
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.