Spectraforce Technologies
Clinical Review Nurse - Prior Authorization
Spectraforce Technologies, Houston, Texas, United States, 77246
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
Position Summary:
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.
Background & Context:
The team consists of prior authorization nurses supporting Marketplace expansion for Texas. A total of 10 temporary workers will be hired across two schedules.
Key Responsibilities:
* 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.
Qualification & Experience:
* 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
Candidate Requirements
Education/Certification Required:
ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience Preferred:
Licensure Required: RN Preferred:
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
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
Position Summary:
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.
Background & Context:
The team consists of prior authorization nurses supporting Marketplace expansion for Texas. A total of 10 temporary workers will be hired across two schedules.
Key Responsibilities:
* 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.
Qualification & Experience:
* 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
Candidate Requirements
Education/Certification Required:
ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience Preferred:
Licensure Required: RN Preferred:
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