Clinical Review Nurse - Prior Authorization

Position Title: Clinical Review Nurse - Prior Authorisation

Work Location: Fully Remote, TX

Assignment Duration: 3 months (Potential to extend and/or convert )

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

? Shift 10 AM-7 PM CST - 1 hour lunch

Work Arrangement: Fully Remote, TX (central time zone preferred)

Position Summary:

* Purpose: to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections

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 a Graduate from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 - 4 years of related experience.

* Required: RN

* 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-organised