Position Title: Clinical Review Nurse – Prior Authorization Work Location: Remote – Texas Assignment Duration: 03 Months Possibility to extend or convert Work Schedule: Schedule may vary: Training will be 8am-5pm Monday through Friday. Once training is completed, the scheduled will either be Tuesday- Saturday- 10a-7pm Tuesday -Saturday or Sunday- Thursday 10a-7pm. Manager will review schedules in the interview as well. Work Arrangement: Remote Position Summary: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Key Responsibilities: • Filtering assignments, processing prior authorizations for Texas Ambetter to maintain compliance and turn around time. Candidate Requirements Required: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Preferred: BSN preferred, ADN accepted Required: RN License Preferred: Years of experience required: 2-4 years prior authorization experience from the insurance side. Disqualifiers: Additional qualities to look for: Knowledge with TruCare and/or Interqual (IQ) Top 3 must-have hard skills stack-ranked by importance 1 Proficiently navigating all required programs, systems, and computer applications 2 The ability to work efficiently and accurately in a fast?paced environment 3 Being a team player who can adapt well to change Applicant Notices & Disclaimers For information on benefits, equal opportunity employment, and location-specific applicant notices, click here At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 37.00/hr.