Clinical - Clinical Review Nurse - Prior Authorization

2 days ago


Houston, United States Axelon Full time

Location: Remote - sourced nationally.

SHIFT: Monday - Friday (8 hours)

In the beginning they will not have a set weekend commitment. Once the new hire is fully trained, they are going to have to work (8) hours per day Monday - Friday. (Can be EST (highly preferred), CST (second preference). ( Client will negotiate schedules. If someone is willing to work weekends that would be in the future. On the weekends we have a skeleton crew and generally do not schedule new staff because there is limited support .)

Hiring leaders are open to working with various times. (8:00 a.m. - 5:00 p.m. can work within their time zone) Duration: Contract to Hire
Walk me through the day-to-day responsibilities of this the role and a description of the project:

  • Reviewing authorization requests
  • Utilizing evidence-based criteria and making a medically necessary determination.
  • Outreach calls to providers to request additional details if applicable.
  • They will not be completing any calls to members.

Internal/External Groups with which the Candidate will interface: Required Skills/Experience: Preferred Skills/ Experience: 1. ICU, Medical Surgical background, bedside experience (Home health nurses) 1. Medicare experience (Utilization Management with Medicare) 2. Utilization Review (Prior Authorization) 2. CCM Certification 3. cute Care 3. CLS Certification Education Requirement: Bachelors with RN or RN without Bachelors is okay too Education Preferred: Software Skills Required: TruCare is the system the team uses so if they have experience it is beneficial. Microsoft Office Systems Required Certifications: RN is what the team is really looking for (If the person has an RN license without a bachelors, they are okay)

LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria. Required Testing: n/

  • Houston, United States Spectraforce Technologies Full time

    Title: Clinical Review Nurse - Prior Authorization Duration: 03 Months (Contract to Hire) Location: Remote - Nationally Sourced Shift: Monday - Friday. (Can be EST (highly preferred), CST (second preference). (We can negotiate schedules. If someone is willing to work weekends that would be in the future. On the weekends we have a skeleton crew and generally...


  • Houston, United States Axelon Services Corporation Full time

    Location: Remote sourced nationally. SHIFT: Monday Friday (8 hours) In the beginning they will not have a set weekend commitment. Once the new hire is fully trained, they are going to have to work (8) hours per day Monday Friday. (Can be EST (highly preferred), CST (second preference). (Client will negotiate schedules. If someone is...


  • Houston, United States Elevance Health Full time

    **Pharmacist Clinical- Prior Authorization (Pharmacist Clinical)** _Location: Virtual with the ideal candidate living within 50 miles of one of our Elevance Health PulsePoint locations._ The **Pharmacist Clinical** is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary...


  • Houston, Texas, United States US Tech Solutions Full time

    Job Title: Clinical Pharmacist Advisor - Specialty Medical Prior AuthorizationLocation: RemoteDuration: 6+ months contractJob Description:The clinical pharmacist is an operation-based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.The clinical pharmacist will apply clinical knowledge to...

  • Clinical Pharmacist

    3 weeks ago


    Houston, Texas, United States Integrated Resources Full time

    Job Summary:The Clinical Pharmacist will be responsible for conducting clinical reviews of medical data to perform prior authorization for specialty medications. This role will work from Client Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.Key...

  • Clinical Pharmacist

    4 weeks ago


    Houston, Texas, United States Integrated Resources Full time

    {"Job Summary Integrated Resources is seeking a highly skilled Clinical Pharmacist to join our team in a remote work environment. Job Description As a Clinical Pharmacist, you will be responsible for conducting clinical reviews of medical data to perform prior authorization for specialty medications. You will apply clinical knowledge to plan approved...


  • Houston, United States Premier Medical Resources Full time

    Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who...


  • Houston, Texas, United States A-Line Staffing Solutions Full time

    Job Summary:We are seeking a skilled Pharmacist to join our team as a Prior Authorization Specialist. This is a remote opportunity that requires strong clinical knowledge and independent problem-solving skills.Key Responsibilities: Perform clinical review of prior authorization requests Coordinate the distribution of clinical drug information Educate...


  • Houston, Texas, United States WEP Clinical Full time

    Job Title: Mobile Research NurseJob Summary: We are seeking a skilled and compassionate nurse with a passion for clinical research to join our dynamic team at WEP Clinical. As a Mobile Research Nurse, you will play a crucial role in ensuring the successful execution of research studies.Key Responsibilities:Administer investigational medications/products as...


  • Houston, Texas, United States WEP Clinical Full time

    Job Title: Mobile Research NurseJob Type: Contract, PRN, Per diemHourly Rate: $55/hr onsite and $50/hr travel timeWork Location: Houston, Texas; On the roadJob Description:We are seeking a dedicated individual with current acute care or homecare experience and phlebotomy skills to work under the guidance of the principal study investigator and nursing...


  • Houston, Texas, United States WEP Clinical Full time

    Mobile Research NurseWe are seeking a skilled and compassionate nurse with a passion for clinical research to join our dynamic team as a Mobile Research Nurse. As a key member of our team, you will play a crucial role in ensuring the successful execution of research studies.Key Responsibilities:Administer investigational medications/products as needed, and...


  • Houston, Texas, United States DM Clinical Research Full time

    Job SummaryWe are seeking a highly skilled and experienced Regional Director to lead our clinical research operations. The successful candidate will provide strategic leadership, project management, and oversight for multiple locations, ensuring the successful execution of clinical trials in accordance with Sponsor goals, Standard Operating Procedures...


  • Houston, Texas, United States Onco360 Full time

    Job Title: Pharmacy Prior Authorization SpecialistJob Summary:Onco360 Pharmacy is seeking a highly skilled Pharmacy Prior Authorization Specialist to join our team. As a Pharmacy Prior Authorization Specialist, you will play a critical role in ensuring patients receive the medication they need by obtaining prior authorizations from insurance carriers.Key...


  • Houston, Texas, United States Team1Medical Full time

    Job DescriptionTeam1Medical is seeking a skilled Prior Authorization Specialist to join their team at an accredited cardiology center in North Houston. The ideal candidate will have experience working with insurance verification in a specialty clinic and thrive in a fast-paced environment.Responsibilities:Comply with pre-certification information and forward...


  • Houston, United States Clinical Management Consultants Full time

    Elevate your nursing career in the Greater Houston Area as a PACU Clinical Nursing Manager with this exciting opportunity. Join a dynamic team and make a meaningful impact in patient care today!The facility is a community medical center committed to providing exceptional healthcare services. Renowned for cutting-edge medical technology, comprehensive...


  • Houston, United States Clinical Management Consultants Full time

    Elevate your nursing career in the Greater Houston Area as a PACU Clinical Nursing Manager with this exciting opportunity. Join a dynamic team and make a meaningful impact in patient care today! The facility is a community medical center committed to providing exceptional healthcare services. Renowned for cutting-edge medical technology, comprehensive...


  • Houston, United States Clinical Management Consultants Full time

    Elevate your nursing career in the Greater Houston Area as a PACU Clinical Nursing Manager with this exciting opportunity. Join a dynamic team and make a meaningful impact in patient care today!The facility is a community medical center committed to providing exceptional healthcare services. Renowned for cutting-edge medical technology, comprehensive...


  • Houston, United States Clinical Management Consultants Full time

    Job DescriptionElevate your nursing career in the Greater Houston Area as a PACU Clinical Nursing Manager with this exciting opportunity. Join a dynamic team and make a meaningful impact in patient care today!The facility is a community medical center committed to providing exceptional healthcare services. Renowned for cutting-edge medical technology,...


  • Houston, United States Clinical Management Consultants Full time

    Elevate your nursing career in the Greater Houston Area as a PACU Clinical Nursing Manager with this exciting opportunity. Join a dynamic team and make a meaningful impact in patient care today! The facility is a community medical center committed to providing exceptional healthcare services. Renowned for cutting-edge medical technology, comprehensive...


  • Houston, Texas, United States Axsendo Clinical Full time

    Job OverviewAt Axsendo Clinical Research, we are seeking a highly skilled and experienced Lead Clinical Research Coordinator to join our dynamic team. As a key member of our research team, you will be responsible for overseeing the coordination of clinical research studies, ensuring compliance with regulatory requirements, and providing exceptional support...