Clinical Review Nurse - Prior Authorization

Position Title : Clinical Review Nurse - Prior Authorization
Work Location : Remote - US MST, CST, EST only
Assignment Duration : 12 Months
Work Schedule : 8 to 5 CST (1 hour lunch)
* Sunday through Thursday or
* Tuesday through Saturday or
* Wednesday through Sunday
No OT
Work Arrangement : Remote
Illinois or Compact license

Position Summary :
Medicaid and Marketplace prior authorization reviews.
This position is needed to support key strategic initiatives and process improvement projects. Dedicated resources are required to ensure project deliverables are met while maintaining day-to-day operational responsibilities.

Background & Context :
Fast-paced and collaborative, focused on regulatory compliance, operational excellence, and delivering timely, accurate authorization decisions.
Multi states with Medicaid and marketplace plans.

Key Responsibilities :
* Review prior authorization requests within turnaround times while maintaining quality standard.
* 14 to 16 reviews per day. Quality score of 95% or higher.

Candidate Requirements Required: graduated from accredited nursing program or Bachelor's degree in Nursing Preferred: Required: LPN or LVN Preferred: RN Years of experience required: 2-4 years of related experience

Disqualifiers: No Illinois or Compact license

Additional qualities to look for: compact license or multistate licensure

• Top 3 must-have hard skills stack-ranked by importance

1 Prior experience with prior auth reviews 2 organized 3 Comfortable on the computer - especially MS Office Suite