Clinical Review Nurse - Prior Authorization
 Spectraforce Technologies | |||||||||||||||||||||||||||
 United States, North Carolina, Raleigh | |||||||||||||||||||||||||||
| 500 West Peace Street (Show on map) | |||||||||||||||||||||||||||
 Jan 28, 2025 | |||||||||||||||||||||||||||
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Title: Clinical Review Nurse - Prior Authorization Duration: 12 Months Location: Remote (CST) Shift: 9am-6pm cst zone. OT may be required but will have opportunities based on business needs Note: News Years Day, Thanksgiving Day and Christmas Day guaranteed holidays and off. Other holidays, based on business needs, may be asked to work. We have a rotating weekend schedule typically every 5 weeks and once training is finished, you will work Sat and Sun 8 hours each day.2 days during the week will offset that weekend expectation that you have the choice of choosing off. Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD): Address any email correspondence, read Teams message for updates, view calendar for important meetings/huddles/training for day, may have up to 10-15 calls to providers daily, Describe the performance expectations/metrics for this individual and their team: *Meets and Maintains productive standard (15++ Reviews/day no exceptions to the change of this expectation) *Appropriately refers cases for secondary review as evidenced by appropriate benchmark range and quality audits- RN to MD Referral Rate *Meets and Maintain TAT performance (100%) *Quality reviews >/= 95% monthly *Demonstrated comprehension of criteria application (IQ/IQC/MCG; Pass IRR annually) *Understanding of Clinical Documentation System *Basic Excel Skills *Professional and courteous communication skills
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