Clinical Review Nurse- Prior Authorization

Pacer Group; Ohio; Remote; Full time

Job summary

A leading staffing and recruiting company is seeking a Clinical Review Nurse for a remote role focusing on prior authorization for Medicaid. This full-time position requires strong computer and medical knowledge, along with care management or nursing experience. The position includes responsibilities such as reviewing authorization requests, with a supportive work environment valuing teamwork and quality documentation.

Qualifications

• Graduate from an accredited School of Nursing with 2-4 years related experience.
• Computer skills and medical knowledge are essential.
• Care management or clinical nursing experience is required.

Responsibilities

• Review prior authorization requests for Medicaid Line of Business.
• Assist in reviewing backlog requests from providers.
• Participate in biweekly virtual team huddles.

Skills

Computer skills

Medical knowledge

Prior authorization experience

Education

Bachelor's degree in Nursing

Job description

Clinical Review Nurse - Prior Authorization

Join to apply for the Clinical Review Nurse - Prior Authorization role at Pacer Group.

Position Details

• Title: Clinical Review Nurse - Prior Authorization
• Duration: 6 months
• Shift: 8 am - 5 pm
• Location: Remote OH
• Pay rate: $40.00 - $42.00

Responsibilities

• Review of prior authorization requests for Medicaid Line of Business
• Assist the PA Team in reviewing backlog requests from providers
• Participate in biweekly virtual team huddles and follow emailed instructions
• Proficient in toggling between multiple systems

Must Haves

• Computer skills and medical knowledge
• Care management or clinical nursing experience

Nice to Haves

• Experience as Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management, or Quality Assurance Nurse

Performance Indicators

• Quality documentation
• Timely processing of up to 18 authorizations per day
• Team player with a positive attitude

Top Skills

• Computer skills
• Prior authorization experience
• Medical knowledge

Education

• Graduate from an accredited School of Nursing or Bachelor's degree in Nursing with 2-4 years of related experience

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industries: Staffing and Recruiting