Clinical Review Nurse – Prior Authorization

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

Job ID:25-92819

Pay Range: $38 - $42/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:

• Purpose: 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 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.

Key Requirements and Technology Experience:

• Skills-RN License,Prior Auth and Trucare 
• ADN, BSN - Requires Graduate from an Accredited School of Nursing or bachelor’s degree in nursing and 2 – 4 years of related experience
• Adaptable to change
• Quick processing, critical thinking
• Well organized
• True care experience
• 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
• Location: Fully Remote, TX, central time zone preferred, must have compact state licensure an/or Texas licensure

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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