Clinical - Clinical Review Nurse - Prior Authorization - J00927

Location : Fully Remote, from TX (Central time zone preferred, Must have compact state licensure and / or Texas licensure)

Shift : Training - 4-5 weeks Mon - Fri 8AM 5PM CST (No days off) CAMERA ON; Shift schedule Mon - Fri 10 AM-7PM CST - 1 hour lunch

Duration : 3 months with potential to extend or convert if a position opens.

Job Description / Job Profile Summary

Position Purpose :

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

Typical Day in the Role

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.

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