Remote Clinical Review Nurse - Prior Authorization

Spectraforce Technologies, Inc.; Las Vegas (NV); Remote; USD 80,000 - 105,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for remote work with PST/CST alignment. The role evaluates pre-authorization requests to confirm medical necessity and appropriate care levels per standards and payer coverage.

The ideal candidate has an RN license with 2–4 years of PA experience, knowledge of InterQual/Milliman, and strong organizational skills to support fast-paced clinical decisions.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2-4 years of related experience
• Preferred NV or Compact RN license

Responsibilities

• Review prior authorization requests for medical necessity and appropriate level of care according to standards and coverage.
• Assess complex requests and provide recommendations to the medical team to promote quality and cost effectiveness of care.

Skills

Prior Authorization

InterQual/Milliman

Organizational Skills

Education

Nursing degree (RN)

Job description

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for remote work with PST/CST alignment. The role evaluates pre-authorization requests to confirm medical necessity and appropriate care levels per standards and payer coverage.

The ideal candidate has an RN license with 2–4 years of PA experience, knowledge of InterQual/Milliman, and strong organizational skills to support fast-paced clinical decisions.