Clinical Review Nurse – Prior Authorization
Clinical Review Nurse – Prior Authorization (Remote CST Hours) Location: Remote Schedule: Monday–Friday, 10:00 AM–7:00 PM CST with rotating weekends Training Schedule: Monday–Friday, 8:00 AM–5:00 PM CST Pay Rate: $40.00–$43.00/hour Employment Type: W2 Contract – 3 Month Assignment with potential for extension We are hiring a Clinical Review Nurse to support prior authorization and utilization review operations in a fully remote setting. This role focuses on reviewing authorization requests, evaluating medical necessity, coordinating with providers, and ensuring timely approvals and continuity of care for members. Candidates must be comfortable working CST hours regardless of time zone. Job Responsibilities
- Perform medical necessity and clinical reviews of prior authorization requests using regulatory guidelines and established clinical criteria
- Review documentation to determine medical appropriateness of requested services and care
- Coordinate with healthcare providers and internal authorization teams to ensure timely processing of requests
- Escalate cases to Medical Directors when additional clinical review is required
- Support transfer and discharge authorization requests to help facilitate timely transitions between levels of care and facilities
- Collect, document, and maintain member clinical information within health management systems
- Assist with educating providers and internal teams on utilization management and authorization processes
- Identify and communicate opportunities to improve authorization workflows and review processes
- Maintain compliance with company policies, clinical standards, and regulatory requirements
- Perform additional duties as assigned
Required Qualifications
- Graduate of an accredited School of Nursing or Bachelor’s degree in Nursing
- Active RN license required (Texas RN license or Compact RN license)
- Multiple years of directly related prior authorization, utilization review, or clinical review experience
- Experience reviewing medical necessity and authorization requests
- Strong understanding of utilization management processes and clinical documentation
- Ability to work independently in a remote environment
- Strong communication and organizational skills
Preferred Backgrounds Candidates with experience in the following areas are encouraged to apply:
- Prior Authorization Nurse
- Utilization Review Nurse
- Case Management Nurse
- Clinical Review Nurse
- Concurrent Review Nurse
- Managed Care Nurse
- UM Nurse
- Appeals and Grievances
- Health Plan or Insurance Experience
- Hospital Case Management
- Discharge Planning
- Care Coordination
. Remote Skills: Case Management, Certified Case Manager (CCM), Clinical Information, Clinical Nursing, Clinical Practices/Protocols, Clinical Study Publications, Clinical Validation, Communication Skills, Corporate Policies, Customer Escalations, Discharge Plans, Documentation Review, Health Information Management, Health Insurance, Health Plan, Healthcare Providers, Healthcare Software, Hospital Administration, Maintain Compliance, Managed Care, Nursing, Nursing Credentials, Nursing Management, Operational Audit, Organizational Skills, Patient Care Authorizations, Registered Nurse (RN), Regulations, Regulatory Requirements, Time Management, Utilization Management About the Company: A-Line Staffing Solutions LLC A-Line Staffing Solutions is a premier staffing company that supplies professionals to the Healthcare, Insurance, Pharmaceutical, and Information Technology industries. Founded in 2004, A-Line Staffing Solutions has been a leader in matching talented individuals to the jobs that our clients NEED to fill. We are experts at offering creative staffing solutions to employers, and we are hiring every day. A-Line Staffing can offer short-term, long-term and direct-hire opportunities to professionals across the United States. We hire only the most qualified and talented individuals in the country. Our recruiting, selection and stringent screening processes have strengthened our reputation for delivering quality customer service and unbeatable talent. For our commissioned clients, A-Line Staffing closely follows the standards and practices established by The Joint Commission. For all of our clients and employees, our commitment to continual improvement combined with a strict code of ethics provides an atmosphere of respect and unparalleled professionalism. To find out how A-Line Staffing Solutions can share our talent with you, please contact us today. We are eager to include you among our most valued and satisfied clients. If you are a professional and would like to learn more about open opportunities in your area, please contact us today. We are always searching for talented and enthusiastic professionals Company Size: 1,000 to 1,499 employees Industry: Staffing/Employment Agencies Founded: 2004 Website: http://www.alinestaffing.com/ Apply tot his job Apply To this Job