What are the responsibilities and job description for the {166056} Prior Authorization - Clinical Review Nurse (RN) position at A-Line Staffing?
A-Line Staffing is now hiring a Clinical Review Nurse – Prior Authorization in (Remote for Nevada residents only).
The Clinical Review Nurse – Prior Authorization will be working for a Major Fortune 500 Company and has career growth potential.
Clinical Review Nurse – Prior Authorization Highlights:
- Work Location: Fully Remote (must reside in Nevada)
- Schedule: Monday–Friday, 8:00 AM – 5:00 PM PST
- Pay Range: $35-$42 Hourly
Clinical Review Nurse – Prior Authorization Responsibilities:
- Review and analyze prior authorization requests to determine medical necessity
- Apply InterQual criteria and utilization management standards
- Request additional clinical information from providers (RFI via phone or fax)
- Document determinations using TruCare and Microsoft applications
- Ensure compliance with Medicaid regulations, HIPAA guidelines, and medical terminology standards
Clinical Review Nurse – Prior Authorization Qualifications:
- Licensure: Active Nevada RN license (required)
- 2–4 years of experience in prior authorization
- Knowledge of Medicaid regulations
- Utilization management experience
- Graduate of an accredited School of Nursing (ASN required; BSN preferred)
- Strong clinical judgment with excellent analytical and critical-thinking skills
- Familiarity with medical terminology and HIPAA guidelines
Preferred Qualifications:
- Experience using TruCare
- Experience applying InterQual criteria
If you are interested in this Clinical Review Nurse – Prior Authorization position, please apply to this posting for immediate consideration with Silvana M with A-Line!
INDSV
Job Types: Full-time, Contract
Pay: $38.00 - $41.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Work Location: Remote
Salary : $35 - $42