Clinical Review Nurse - Prior Authorization

You will perform clinical reviews for prior authorization requests in a remote capacity.

Responsibilities

• Review clinical documentation against established regulatory guidelines.
• Apply state policy requirements to authorization decisions.
• Manage caseload according to East Coast time zone schedules.
• Maintain clinical accuracy during weekday shifts and alternating weekend hours.

Required Skills

• Licensed Practical Nurse (LPN) credentials.
• 5+ years of clinical experience.
• Proficiency with ACLS protocols.
• Working knowledge of regulatory guidelines.
• Understanding of state policy frameworks.
• Ability to work Monday to Friday, 8:00 a.m. – 5:00 p.m. ET.
• Availability for alternating weekend shifts (2 hours per day).