Clinical Review Nurse - Prior Authorization

Spectraforce Technologies
remote work
United States, Ohio, Columbus
Jun 19, 2025
Position Title: Clinical Review Nurse-Prior Authorization Work Location: Remote, Ohio EST Assignment Duration: 6 months (Possibility to extend or convert) Work Schedule: 8 am-5 pm Background & Context: BHP Prior Authorization Clinical Review Nurse Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems Review of prior auth requests for Medicaid Line of Business. To assist the PA Team reviewing a backlog of requests from providers Additional business needs for support Key Responsibilities: Monday thru Friday remote work. (8a-5p) Clinical review and documentation of medical request for prior authorization of medically necessary services, sitting in front of a computer for 8 hours with allowance for breaks and 1 hour lunch, biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems Remote work Qualification & Experience: Required: Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2-4 years of related experience. Required: Nursing Licensure Must haves: Computer skills, medical knowledge, Care manager or clinical nursing experience, Word, Excel, Virtual meeting skills, MS outlook and EMR systems Nice to haves: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse experience; Critical thinking skills; good people skills and able to communicate needs; Comfortable with provider interaction Disqualifiers: not having the requirements mentioned, remaining disqualifiers TBD during interview Performance indicators: Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude Top 4 must-have hard skills (stack-ranked): RN/LPN licensed professional Comfortable toggling between multiple computer systems Very agile and comfortable in fast paced environment Prior Authorization experience