New

Clinical Review Nurse - Prior Authorization

Spectraforce Technologies

United States, North Carolina, Raleigh

500 West Peace Street (Show on map)

Oct 10, 2026

Position Title: Clinical Review Nurse - Prior Authorization

Work Location: Remote (must be clinically licensed in NC, DE, NH, NJ, SC; nationwide sourcing accepted; Compact license preferred)

Assignment Duration: 6 months (Possibility to extend or convert)

Work Schedule: Mon - Fri, 8am-5pm EST, No OT

Work Arrangement: Remote

Position Summary:

Review Prior Authorization requests for various service types for the Medicaid LOB.

Background & Context:

Team is collaborative and supportive; Team is REMOTE but team relies heavily on communication. This initiative is multi state/region.

Key Responsibilities:

* Team member will receive an assignment that is LIVE (excel spreadsheet)

* Team member will process various authorization service types using clinical coverage policies or InterQual.

* Team member will submit any requests that do not meet criteria to second level review (MD) for a determination.

* 12-15 nurse reviews per day

Qualification & Experience:

Education/Certification	Required: Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing	Preferred:
Licensure	Required: LPN COMPACT	Preferred: RN Compact
Years of experience required: 3+ related experience Disqualifiers: Additional qualities to look for: Organized team player who is willing to learn in a fast pace environment
Top 3 must-have hard skills stack-ranked by importance	1	Computer literacy
2	Prior experience with prior authorization
3	Prior experience using state clinical coverage policies (Medicaid)
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations	Projected Manager Candidate Review Date:	1-2 days post shortlisting
Type of Interviews:	TEAMS - camera on
Required Testing or Assessment (by Vendor):	NA