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Clinical Review Nurse - Prior Authorization Job in Grove City, Ohio US

Clinical Review Nurse - Prior Authorization

Spectraforce Technologies Inc - Grove City, OH

Posted: 6/20/2025 - Expires: 9/18/2025

Job ID: 290735990

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Job Description

Position Title: Clinical Review Nurse-Prior Authorization
Work Location: Remote, Ohio EST
Assignment Duration: 6 months (Possibility to extend or convert)
Work Schedule: 8 am-5 pm

Background & Context:

BHP Prior Authorization Clinical Review Nurse

Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems

Review of prior auth requests for Medicaid Line of Business.

To assist the PA Team reviewing a backlog of requests from providers

Additional business needs for support

Key Responsibilities:

Monday thru Friday remote work. (8a-5p)

Clinical review and documentation of medical request for prior authorization of medically necessary services, sitting in front of a computer for 8 hours with allowance for breaks and 1 hour lunch, biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems

Remote work

Qualification & Experience:

Required: Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2-4 years of related experience.

Required: Nursing Licensure

Must haves: Computer skills, medical knowledge, Care manager or clinical nursing experience, Word, Excel, Virtual meeting skills, MS outlook and EMR systems

Nice to haves: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse experience; Critical thinking skills; good people skills and able to communicate needs; Comfortable with provider interaction

Disqualifiers: not having the requirements mentioned, remaining disqualifiers TBD during interview

Performance indicators: Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude

Top 4 must-have hard skills (stack-ranked):

RN/LPN licensed professional

Comfortable toggling between multiple computer systems

Very agile and comfortable in fast paced environment

Prior Authorization experience

SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at nahr@spectraforce.com if you require reasonable accommodation.

Job Summary

Employment Type:
Full Time Employee
Job type:
Federal Contractor
Skill Based Partner:
No
Education Level:
Bachelor's degree
Work Days:
Mon, Tue, Wed, Thu, Fri
Job Reference Code
83982193
Salary
N/A
Licenses / Certifications:
N/A
Display Recommended WorkKeys®Recommended WorkKeys®:
Applied Math: 4
Graphic Literacy: 5

Workplace Documentation: 4