Clinical Review Nurse - Prior Authorization

Position Title: Clinical Review Nurse - Prior Authorization

Work Location: Fully Remote, TX (central time zone preferred; must have compact state licensure and/or Texas licensure)

Assignment Duration: 3 months Potential to extend and/or convert if position opens

Work Schedule: Training - 4-5 weeks, 8AM - 5PM CST (No days off) CAMERA ON; Shift 10 AM-7PM CST - 1 hour lunch

Work Arrangement: Remote

Perform prior authorization clinical reviews for Texas Marketplace members, and assist with non-par (out of network) redirections. Training will be handled at the team level and collaboration with team members is available to answer questions.

The team consists of prior authorization nurses supporting Marketplace expansion for Texas. A total of 10 temporary workers will be hired across two schedules.

* Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed.

* Additionally, will assist with out of network requests and redirecting to in network providers as needed.

* Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out of network requests will perform 2 redirections per hour.

* This role is unique as it supports Marketplace expansion for Texas.

* Required: ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience

* Licensure Required: RN

* Years of experience required: 2-4 years

* Disqualifiers: LVN

* Additional qualities to look for: True care experience

* Top 3 must-have hard skills stack-ranked by importance

1 Adaptable to change

2 quick processing, critical thinking

3 well organized