Clinical Review Nurse - Prior Authorization

Davita Inc.; Raleigh (NC); Remote; USD 65,000 - 85,000; Full time

Job summary

A leading healthcare company is seeking a Clinical Review Nurse - Prior Authorization. This remote position involves reviewing prior authorization requests for Medicaid and requires a graduate nursing degree, relevant experience, and nursing licensure. The role emphasizes teamwork, quality documentation, and proficient multitasking. Ideal candidates will have medical knowledge and experience in prior authorizations.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing.
• 2-4 years of related experience.
• Nursing Licensure required.

Responsibilities

• Review of prior auth requests for Medicaid Line of Business.
• Quality documentation for timely processing of up to 18 authorizations per day.

Skills

Computer skills

Medical knowledge

Prior authorization previous experience

Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing

Job description

Position Title: Clinical Review Nurse - Prior Authorization

Work Location: Ohio - Remote (EST)

Duration: 6 months, possible extension

Schedule: Monday thru Friday, 8 am - 5 pm (adjustable based on PA team need, no OT)

Position Summary:

* Review of prior auth requests for Medicaid Line of Business.

* To assist the PA Team reviewing a backlog of requests from providers.

Background & Context:

The PA team works well together - always assisting each other as needed. Teams work closely together and very supportive.

Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems.

To assist the PA Team reviewing a backlog of requests from providers.



Key Responsibilities:

* Review of prior auth requests for Medicaid Line of Business.

* Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems.

* Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude.

Qualification & Experience:

* Required: Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.

* Required: Nursing Licensure.

* Must haves: Computer skills, medical knowledge, care manager or clinical nursing experience.

* Nice to haves: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse.

Candidate Requirements
Education/Certification	Required: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.	Preferred:
Licensure	Required: Nursing Licensure	Preferred:
Years of experience required Disqualifiers Best vs. average Performance indicators	Must haves: Computer skills, medical knowledge, Care manager or clinical nursing experience Nice to haves: Works well for this role: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse Performance indicators: (Meet expectations) Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection	1	Computer skills
2	Prior authorization previous experience
3	Medical knowledge