Utilization Review Nurse

Job Title: Clinical Review Nurse – Prior Authorization

Duration: 3 months Contract (Potential to extend)

Location: Fully Remote, TX, central time zone preferred

Shift Type: Monday-Friday 10 AM-7PM CST- 1 hour lunch , Training – 4-5 weeks 8AM – 5PM CST (No days off) CAMERA ON

Job Duties:

• 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. 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.

Years of experience required:

• 2–4 years of experience required in a related field.

• Adaptable to change

• Quick processing, critical thinking

• Well organized

Additional qualities to look for:

True care experience

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.

Licensure Required:

Must have compact state licensure an/or Texas licensure.