Prior Authorization Nurse (RN)

Job Title: Prior Authorization Nurse (RN)Location: Remote (Must Reside in PST Time Zone)Pay: $40–$43 per hourSchedule: Full-Time, 40 hours per weekAssignment: 6-Month Contract-to-Hire (Goal to Convert to Permanent After 6 Months)Job SummaryA-Line Staffing is seeking an experienced Prior Authorization Nurse (RN) to support Dual-eligible Medicare/Medicaid members in a fully remote capacity. In this role, you will review and evaluate prior authorization requests to determine medical necessity, appropriateness of care, and alignment with established clinical guidelines and utilization management policies.This is an excellent opportunity for an RN with strong managed care and utilization management experience who is looking for a long-term opportunity with permanent potential.Key ResponsibilitiesReview prior authorization requests for medical services, procedures, medications, and treatments to determine medical necessityEvaluate clinical documentation to ensure requested services meet established criteria and guidelinesApply Medicare and Medicaid regulations to authorization determinationsCommunicate determinations and additional documentation needs to providers and internal teamsCollaborate with Medical Affairs and/or Medical Directors when cases require clinical review or escalationAccurately document authorization decisions, clinical findings, and actions taken in health management systems in accordance with utilization management policiesRequired QualificationsGraduate from an accredited School of Nursing or Bachelor’s degree in NursingActive RN license in the state of current residence3–4 years of experience in managed care, prior authorization, healthcare authorizations, concurrent review, or utilization managementPreferred QualificationsClinical knowledge with ability to assess treatment needs and appropriate levels of careExperience working with Dual-eligible Medicare/Medicaid populationsKnowledge of utilization management processes and prior authorization workflowsCompensation & Benefits$40–$43 per hourFull-time schedule (40 hours per week)6-month contract-to-hire opportunity with strong potential for permanent placementFully remote role (PST time zone required)If you are interested in this position and want to learn more, feel free to reach out to Chris with A-Line Staffing at chojsan@alinestaffing.com or apply to this posting!

Salary : $40 - $43