Prior Authorization Nurse

IMCS Group; Ohio; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking a Clinical Review Nurse specializing in Prior Authorization. This fully remote role involves reviewing authorization requests to ensure compliance and medical necessity. Candidates should possess a nursing degree, an active Ohio license, and clinical experience in a fast-paced environment. Strong communication and critical thinking skills are essential to excel in this role, which offers a competitive hourly rate and the possibility of contract extension.

Qualifications

• Graduate of an accredited School of Nursing.
• Active RN or LPN licensure (Ohio-based).
• 2–4 years of clinical nursing experience.

Responsibilities

• Review clinical requests for medical necessity and prior authorization.
• Collaborate with providers for clinical clarifications.
• Meet daily productivity goals of up to 18 authorizations.

Skills

Critical thinking

Communication

Collaboration

Attention to detail

Self-motivation

Agility

Education

Bachelor’s in Nursing

Tools

MS Word

Excel

Outlook

EMR systems

Job description

3 days ago Be among the first 25 applicants

This range is provided by IMCS Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$35.00/hr - $43.00/hr

Job Title: Clinical Review Nurse – Prior Authorization

Duration: 6 months (possibility to extend)

Schedule: Monday–Friday, 8:00 AM – 5:00 PM (No OT)

Job Summary:

The Clinical Review Nurse – Prior Authorization is responsible for reviewing and processing prior authorization requests for Medicaid members to ensure medical necessity and compliance with plan guidelines. This role is fully remote and requires strong clinical judgment, multitasking in multiple systems, and adherence to documentation timelines.

Key Responsibilities:

• Review and document clinical requests for medical necessity and prior authorization.
• Navigate multiple systems efficiently to support review processes.
• Collaborate with providers via phone or email for clinical clarifications.
• Meet daily productivity goals of up to 18 authorizations.
• Participate in virtual biweekly team huddles and training.
• Maintain quality documentation and support team initiatives as needed.

Required Qualifications:

• Graduate of an accredited School of Nursing or Bachelor’s in Nursing.
• Active RN or LPN licensure (Ohio-based).
• 2–4 years of clinical nursing or care management experience.
• Strong computer skills including MS Word, Excel, Outlook, and EMR systems.
• Experience in a fast-paced, metric-driven environment.
• Excellent critical thinking, communication, and collaboration skills.

Preferred Experience:

• Prior Authorization, Medical Review, Appeals, Utilization Management, or Quality Assurance.
• Background in Medicaid managed care is highly desirable.
• Comfortable with provider interaction and issue resolution.

Soft Skills:

• Agile, detail-oriented, and self-motivated.
• Able to manage workload independently while contributing to a supportive team.
• Strong verbal and written communication skills.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care and Public Health

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