Remote RN: Prior Authorization & Medical Necessity Review

Spectraforce Technologies, Inc.; Houston (TX); Remote; USD 70,000 - 100,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for a 12-month assignment. The role is remote (PST/CST) with scheduling across multiple shifts, supporting national guidelines and contractual requirements.

You will review PA requests for medical necessity, assess complex cases, and guide the medical team to ensure appropriate care while aligning with compliance standards. RN licensure is required, with preferred NV/Compact credentials.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing with 2–4 years of experience
• RN license in state; NV or Compact RN license preferred
• Prior PA experience with InterQual/Milliman; knowledge of Utilization Management

Responsibilities

• Routinely reviews prior authorization requests to determine medical necessity and appropriate level of care.
• Assesses more complex authorization requests and provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
• Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria

Skills

Utilization Management

Prior Authorization

InterQual/Milliman

Regulatory knowledge

Team player

Education

Nursing degree

RN License

Tools

OneNote

Microsoft Office

Job description

Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for a 12-month assignment. The role is remote (PST/CST) with scheduling across multiple shifts, supporting national guidelines and contractual requirements.

You will review PA requests for medical necessity, assess complex cases, and guide the medical team to ensure appropriate care while aligning with compliance standards. RN licensure is required, with preferred NV/Compact credentials.