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Clinical Review Nurse - Prior Authorization

Spectraforce Technologies
United States, Washington, Seattle
Sep 17, 2025
Position Title: Clinical Review Nurse - Prior Authorization Work Location: Remote: WA / OR (PST Time Zone). WA can have a compact state license. OR is not a compact state, so they will have to have an OR license or be willing to get one. Assignment Duration: 3 months Work Schedule: Shift: Tues- Saturday 8 am- 5 pm EST; no OT expectations Position Summary: Performs medical necessity and clinical reviews of authorization requests to determine the medical appropriateness of care in accordance with regulatory guidelines and criteria Key Responsibilities: Works with healthcare providers and the authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess the medical necessity of care of member Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care Assists with service authorization requests for a member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collects, documents, and maintains all member's clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Performs other duties as assigned Qualification & Experience: Candidate Requirements- LPN/RN in Nursing; Must have at least 2 years prior experience in Prior Authorization with an Insurance company Education/Certification Required: LPN/AS RN Preferred: RN Licensure Required: i.e. RN, LPN Preferred: Years of experience required Disqualifiers Best vs. average Performance indicators Must haves: 2 years experience with PA or IP auth reviews Nice to haves: Previous experience with prior auth Willingness to learn Positive attitude Performance indicators: Up to 20 auth reviews per day Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection Willingness to learn the WA / OR Medicaid Plan Prior Auth Review Must be a team player that works well independently Must be willing to work a flexible schedule of 1 weekend a month, a few holidays per year