New

Clinical Review Nurse - Prior Authorization

Spectraforce Technologies

500 West Peace Street (Show on map)

Aug 21, 2026

Position Title: Clinical Review Nurse - Prior Authorization

Assignment Duration: 6 months; potential to extend/convert

Work Schedule: OT as needed (needs approval) / 8am - 5pm CST Mon - Fri / Possible holiday shifts

Work Arrangement: Remote-Central Time Zone preferred

Responsibilities:

Centralized Transplant Unit conducts reviews for various transplant authorizations, across all markets and lines of business.

This is to backfill a Nurse role

The CTU is a small team dedicated solely to transplant reviews, and is constantly learning and researching about various types of transplants, diagnoses, etc.

Consolidate clinical information into an easy-to-read summary.

Conduct medical necessity reviews with clinical information, using clinical policies and criteria.

Collaboration with Medical Directors

Maintain adequate time management as the workload is high and can change throughout the day.

Work with transplant providers at the facilities to gather clinical information.

Ensure appropriate case management and contracting is in place for each transplant authorization.

Candidate Requirements
Education/Certification	Required: RN degree	Preferred: Prior Authorization experience
Licensure	Required: Current state RN license only (no LPNs)	Preferred: Compact Nursing License
Years of experience required: 3+ years of Utilization Management/ Prior Authorization experience. Disqualifiers: Additional qualities to look for: Transplant Medical Necessity Review experience in a Utilization Management environment or Transplant Surgical experience.
Top 3 must-have hard skills stack-ranked by importance	1	Correctly uses and interprets clinical policies and clinical review criteria to determine medical necessity
2	Proficiency in MS Suite and clinical software tools to manage clinical documentation systems
3	Maintains professional and courteous communication with providers and members