Remote Transplant Prior-Authorization Nurse

Spectraforce Technologies; Raleigh (NC); On-site; USD 70,000 - 90,000; Full time

Job summary

Spectraforce Technologies is seeking a Clinical Review Nurse - Prior Authorization for a 6-month assignment, with potential to extend or convert. You will support the Centralized Transplant Unit by performing medical necessity reviews and consolidating clinical information into concise summaries.

The ideal candidate holds an RN license with 3+ years in Utilization Management/Prior Authorization, and preferably transplant review experience.

Qualifications

• RN with active state license.
• 3+ years in Utilization Management/Prior Authorization.
• Transplant review experience preferred.

Responsibilities

• Backfill a Nurse role in Centralized Transplant Unit.
• Consolidate clinical information into concise summaries.
• Conduct medical necessity reviews using clinical policies.
• Collaborate with Medical Directors.
• Coordinate with transplant providers to gather information.
• Ensure appropriate case management and contracting for transplant authorizations.
• Manage workload proactively in a high-volume environment.

Skills

Medical policy interpretation

Clinical documentation

Provider communication

Education

RN degree

Tools

MS Office

Clinical documentation systems

Job description

Spectraforce Technologies is seeking a Clinical Review Nurse - Prior Authorization for a 6-month assignment, with potential to extend or convert. You will support the Centralized Transplant Unit by performing medical necessity reviews and consolidating clinical information into concise summaries.

The ideal candidate holds an RN license with 3+ years in Utilization Management/Prior Authorization, and preferably transplant review experience.