Remote Clinical Review Nurse – Prior Authorization

SPECTRAFORCE; Washington (District of Columbia); Remote; USD 70,000 - 90,000; Full time

Job summary

A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2–4 years experience in Prior Authorization review. Strong documentation and communication skills are essential for maintaining high-quality care. This 12-month contract position offers flexibility in the PST time zone.

Qualifications

• 2–4 years of Prior Authorization review and InterQual experience required.
• Ability to work in a high-volume environment while maintaining accuracy.

Responsibilities

• Conduct medical necessity and clinical reviews of authorization requests.
• Work with healthcare providers for timely service reviews.
• Coordinate with interdepartmental teams for member care assessments.
• Escalate requests to Medical Directors when necessary.
• Document and maintain members' clinical information per guidelines.
• Provide education on utilization processes.

Skills

Active RN license

Prior Authorization review experience

Strong documentation skills

Effective communication skills

Ability to maintain accuracy under pressure

Tools

TruCare

Job description

A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2–4 years experience in Prior Authorization review. Strong documentation and communication skills are essential for maintaining high-quality care. This 12-month contract position offers flexibility in the PST time zone.