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Utilization Review Nurse/ Registered Nurse (100% REMOTE)
Spectraforce Technologies is seeking a remote Utilization Review Nurse/Registered Nurse for a 3-month assignment. The role involves clinical criteria prior authorization setup, configuration support, and denial rationale coding with no direct patient care.
Job Description
Position Summary
Responsible for clinical criteria prior authorization setup to meet client needs and ensure operational efficiency.
Key Responsibilities
- No direct patient care (100% virtual position).
- Responsible for clinical criteria prior authorization setup based on client clinical policy requirements.
- Create questions, answers, and configurations allowing prescribers to reach approval or denial outcomes.
- Create and code denial rationales sent to prescribers and patients using a proprietary web-based platform.
- Provide configuration support for both pharmacy and medical criteria.
- Offer consultative support to explain setup and system requirements to internal business partners.
Qualifications & Experience
- Requires a current RN license in good standing.
- Strong communication, organizational, and self-driven skills.
- Collaborative and 'Team Player' mindset.
- Strategic problem-solving capabilities.
Requirements & Skills
Licenses
RN
Skills
Utilization ReviewPrior AuthorizationPharmacy CriteriaMedical CriteriaCommunicationMicrosoft OfficeProblem SolvingCollaboration