Utilization Review Nurse - RN {167481}

A-Line Staffing is now hiring a Full Time, Remote, Prior Authorization Nurse!**Highly prefer RN's in MST or PST time states with a Compact Licensure!Position OverviewWe are seeking four experienced Clinical Review Nurses – Prior Authorization to join a rapidly growing Medicare/Medicaid DUALS team!This is an exciting opportunity to support a brand-new, pilot-stage product with strong leadership involvement and collaborative team support. The team culture is flexible, family-oriented, and highly supportive — supervisors and resources are actively engaged to ensure success. You will never work in isolation and will play a key role in shaping evolving processes and best practices.Prior Authorization Nurse CompensationThe pay for this position is $38.00-41.00/hr Based on experienceBenefits are available to full-time employees after 90 days of employmentA 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility datesThis is a 6 month contract with the goal to convert directly based on attendance and performance.Prior Authorization Nurse HighlightsThis position is a contract assignment with potential to hire on permanently based upon attendance, performance, and business needsSchedule: The required availability for this position is Monday–Friday, 8-hour shift 7-4pm PST, 8-5pm MST, 10am-7pm EST. Weekend rotation may be required; voluntary weekends possible.Prior Authorization Nurse ResponsibilitiesReview outpatient prior authorization requests (office visits, procedures, therapies, outpatient surgeries, diagnostics, etc.)Conduct utilization management reviews in TruCare Cloud & Classic systemsWork assigned case queues efficiently and accuratelyPerform dual line-of-business reviews (2 reviews per case)Apply medical necessity criteria to determine approval or escalationInterpret clinical documentation to support authorization decisionsCollaborate with supervisors and clinical peers for guidance and case discussionsPrior Authorization Nurse RequirementsActive RN License (Compact licensure preferred)2–4 years of related clinical review or utilization management experienceAbility to perform real-time outpatient case reviewsStrong understanding of medical necessity guidelines (e.g., InterQual)Skilled in interpreting clinical documentation and determining appropriate levels of careASN DegreeStrong work ethic, integrity, and case completion reliabilityPreferred QualificationsCompact RN licensureExperience reviewing Medicare/Medicaid (DUALS) populationsBSN Degree highly preferredPrevious experience in utilization management systems (TruCare preferred)If you're interested interested please apply to this posting for immediate consideration with Silvana M. with A-Line!

Salary : $38 - $41