Immediate need for a talented
Registered Nurse. This is a
06+months contract opportunity with long-term potential and is located in
U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-31615
Pay Range: $37 - $39/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:- Review prior authorization requests across various healthcare service categories for Medicaid members.
- Apply state-specific clinical coverage policies and InterQual criteria to evaluate medical necessity and determine whether requests meet established guidelines.
- Refer cases that do not meet clinical criteria to a physician or appropriate second-level reviewer for final determination.
- Process approximately 12–15 clinical reviews per day while maintaining accuracy and productivity standards.
- Maintain clear, accurate, and timely documentation of clinical reviews and decisions.
- Manage assigned cases using spreadsheets and relevant clinical review systems.
- Communicate effectively with team members and contribute to a collaborative remote work environment.
Key Requirements and Technology Experience:- Key Skills; Active RN compact license.
- Experience using InterQual criteria.
- Familiarity with Medicaid utilization management and medical necessity reviews.
- Ability to adapt quickly in a fast-paced clinical review environment.
- Compact state license (required).
- 3+ years of relevant clinical experience.
- Experience with prior authorization requests.
- MCO experience is a must.
- Strong computer skills and the ability to navigate multiple systems and manage electronic documentation.
- Excellent organizational, communication, and time-management skills.
- Ability to work independently while collaborating effectively with a remote team.
Our client is a leading
Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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