Clinical Review Nurse - Prior Authorization

Position Title: Clinical Review Nurse - Prior Authorization

Work Location: Fully Remote, TX central time zone preferred

Assignment Duration: 3 Months with a potential of extension or conversion

Work Schedule: Shift 10 AM-7 PM CST - 1 hour lunch, weekends

Training - 4-5 weeks 8 AM - 5 PM CST (No days off) CAMERA ON

Position Summary: 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.

Background & Context: Purpose: to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections. Team currently consists of 21 prior authorization nurses performing this work, it is a team effort, collaboration with team members is available to answer any questions and training will be handled at the team level.

Key Responsibilities:

• Performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed.
• Assist with out of network requests and redirecting to in network providers as needed.

Qualification & Experience: