Title: Clinical Review Nurse - Prior Authorization
Location: Remote
Duration: 12 Months | Possible extension or conversion based on business need
Schedule: Monday Friday, standard business hours. Occasional overtime may be requested based on workload or regulatory deadlines
PR: $35-45.00/HR
Responsibilities
The nurse reviewer begins by prioritizing assigned cases according to urgency and turnaround time, reviews clinical records against applicable criteria and benefits, documents findings, communicates requests for missing information, and escalates cases outside nursing authority.
Daily work also includes responding to questions, participating in team huddles or training, and completing required administrative tasks.
Performance is measured through quality and documentation accuracy, productivity, turnaround-time compliance, attendance, and adherence to policies.
The role offers exposure to varied clinical cases and requires sound judgment within a structured, regulated environment.
Education And License Required
Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2-4 years of experience
Active, unrestricted LPN or Registered Nurse license in the applicable state or compact license, as permitted for the assignment
Years of experience required
Disqualifiers:
Inactive, restricted, or encumbered nursing license; inability to meet required schedule or remote-work requirements; insufficient clinical documentation skills; or inability to work independently in a productivity-based environment.
Additional qualities to look for:
Strong critical thinking, organization, attention to detail, professional communication, adaptability, reliability, and comfort learning clinical systems and review criteria.
Skills
Clinical assessment and application of medical-necessity criteria.
Accurate, concise clinical documentation and case management within required turnaround times.
Proficiency with electronic clinical systems, Microsoft Office, and remote collaboration tools.