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Clinical Review Nurse - Prior Authorization

Spectraforce Technologies
United States, Texas, Houston
Jul 16, 2025
Position Title: Clinical Review Nurse - Prior Authorization Work Location: Fully Remote, TX - Central Time Zone preferred Assignment Duration: 3 months Work Schedule: Shift 10 AM-7 PM CST - 1 hour lunch Position Summary: Perform prior authorization clinical reviews for Texas Marketplace members Assist with non-par (out-of-network) redirections Background & Context: Team of 21 nurses performing prior auth reviews 10 temps being hired across 2 shifts Team culture: collaborative, supportive Training handled at team level Key Responsibilities: Perform clinical reviews for prior authorization requests using policies and InterQual Refer to MD if needed Handle out-of-network requests Redirect members to in-network providers Complete 20+ reviews/day Complete 2 redirections/hour if assigned Qualification & Experience: Graduate from Accredited School of Nursing or BSN RN license (Compact or Texas) required 2-4 years of related clinical experience Disqualifier: LVN Must be organized, adaptable, critical thinker Training 4-5 weeks, 8AM-5PM CST, camera on