Remote Prior Authorization Nurse RN or LPN (must reside in Washington or Oregon)

Position Title – Clinical Review Nurse- Prior Authorization Work Location – Remote, must reside in Washington or Oregon (Need WA or OR license) Pay – LPN $40/hr ; RN $45/hr Start date – 10/20/25 Hours – 8-5, Tuesday-Saturday Contract Type – 3 month contract, contract extension or conversion not guaranteed Required Skills & Education: • 2+ years of Prior Auth experience with an insurance company • LPN or RN license in WA or OR • Willingness to learn the WA/OR Medicaid Plan Prior Auth Review Responsibilities: • Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care • Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member • Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care • Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities • Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines • Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members • Provides feedback on opportunities to improve the authorization review process for members #INDJB Job Types: Full-time, Contract Pay: $40.00 - $45.00 per hour Benefits: • Dental insurance • Health insurance • Vision insurance Work Location: Remote Apply tot his job Apply To this Job