Clinical Review Nurse - Prior Authorization

Immediate need for a talented Clinical Review Nurse - Prior Authorization. This is a 03+months Contract to hire opportunity with long-term potential and is located in TX (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-78577

Pay Range: $36 - $40/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift Time & Working Days: 8am – 5pm, Mon to Fri, OT dependent on business needs
• To perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections
• 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 network providers as needed.
• Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out-of-new requests will perform 2 redirections per hour
• This role is unique as it supports Marketplace expansion for Texa

Key Requirements and Technology Experience: 

• Key Skills; Prior Auth, Utilization Review RN
• Must have: 2-4 years of experience,
• Disqualifiers: LVN
•  Adaptable to change
• quick processing, critical thinking
• well organized
• 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
• Licensure Required: RN

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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