What are the responsibilities and job description for the Clinical Review Nurse {166056} 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: $40-$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:
- Candidates must love and be licensed in the state of Nevada
- Strong clinical judgment with excellent analytical and critical-thinking skills
- Graduate of an accredited School of Nursing (ASN required; BSN preferred)
- Licensure: Active Nevada RN license (required)
- Experience:
- 2–4 years of previous experience processing clinical prior authorizations
- Knowledge of Medicaid regulations
- Utilization management experience
- 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 with Chris M. at A-Line Staffing.
INDSV
Pay: $40.00 - $42.00 per hour
Expected hours: 40 per week
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Referral program
- Vision insurance
Experience:
- Clinical prior authorization processing: 2 years (Required)
- Medicaid health plan: 1 year (Preferred)
License/Certification:
- Nevada RN License (Required)
Location:
- Nevada (Required)
Work Location: Remote
Salary : $40 - $42