Clinical Review Nurse - Prior Authorization

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:

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  Training: 4-5 weeks, 8AM-5PM CST (No days off, Camera ON)

  
  
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  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:

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  Perform clinical reviews for prior authorization requests utilizing policies and InterQual

  
  
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  Route cases to MD review when required

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

  
  
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  Complete a minimum of 20 clinical reviews per day

  
  
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  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