Remote Clinical Review Nurse for Prior Authorization

Spectraforce Technologies, Inc.; Jacksonville (FL); Remote; USD 85,000 - 110,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization to perform clinical reviews of authorization requests using established criteria, plan benefits, regulatory requirements, and internal policies. Responsibilities include reviewing documentation, determining medical necessity, requesting information, documenting decisions, and meeting turnaround times. This is a remote role with a 12-month duration and potential extension.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's in Nursing.
• Active, unrestricted LPN or RN license in the applicable state or compact license.
• 2+ years of clinical nursing experience; utilization management or prior authorization preferred.
• Must be able to work remotely and meet schedule requirements.
• Strong critical thinking, organization, attention to detail, and professional communication.

Responsibilities

• Prioritize assigned cases according to urgency and turnaround time.
• Review clinical records against applicable criteria and benefits.
• Document findings clearly and concisely.
• Communicate requests for missing information to providers.
• Escalate cases outside nursing authority when needed.
• Respond to questions from team members and providers.
• Participate in team huddles or training sessions.
• Complete required administrative tasks and maintain compliance.
• Collaborate with providers and internal teams while safeguarding confidentiality.

Skills

Clinical assessment

Medical-necessity criteria

Clinical documentation

Electronic clinical systems

Microsoft Office

Remote collaboration tools

Education

Graduate from Accredited School of Nursing

Bachelor's degree in Nursing

Job description

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization to perform clinical reviews of authorization requests using established criteria, plan benefits, regulatory requirements, and internal policies. Responsibilities include reviewing documentation, determining medical necessity, requesting information, documenting decisions, and meeting turnaround times. This is a remote role with a 12-month duration and potential extension.