Remote Clinical Review Nurse

Clinical Review Nurse – Prior Authorization (Remote)

Schedule:

• Training: Monday–Friday, 8 .–5 .
• Post‑Training:
• Tuesday–Saturday, 10 .–7 ., or Sunday–Thursday, 10 .–7 .

About the Role

We are seeking two Clinical Review Nurses (Prior Authorization). In this role, you will analyze prior authorization requests to determine medical necessity and appropriate levels of care in alignment with national standards, contractual requirements, and member benefit coverage. You will provide recommendations to the medical team to support quality, compliance, and cost‑effective care.

Key Responsibilities

• Review and process prior authorization requests for Texas Ambetter.
• Ensure compliance with turnaround times and regulatory requirements.
• Apply clinical judgment and national guidelines (., InterQual) to determine medical necessity.
• Maintain accuracy and efficiency while navigating multiple systems and applications.
• Monitor and meet performance expectations and productivity metrics.
• Collaborate with internal teams to support quality and compliance initiatives.
• Maintain adherence to state board and regulatory standards.

Required Qualifications

• Graduate of an accredited School of Nursing or Bachelor’s degree in Nursing.
• Active RN license (required).
• 2–4 years of prior authorization experience on the insurance/payer side.
• Strong computer proficiency and ability to navigate multiple systems.
• Ability to work accurately and efficiently in a fast‑paced environment.
• Strong teamwork, adaptability, and communication skills.

Preferred Qualifications

• BSN preferred (ADN accepted).
• Experience with TruCare and/or InterQual (IQ).

Disqualifiers

• Lack of prior authorization experience on the insurance/payer side.
• No active RN license.

Job Type & Location

This is a Contract position based out of Saint Louis, MO.

The pay range for this position is $33.00 - $38.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Feb 28, 2026.