Clinical Review Nurse - Prior Authorization

Spectraforce Technologies

United States, California, Los Angeles

Oct 08, 2025

Position Title: Clinical Review Nurse - Prior Authorization

Work Location: California (Remote)

Assignment Duration: 12 months (Possibility to convert)

Work Schedule: Training 8-5PM PST - 4-6 week course - NO TIME OFF - CAMERA ON 8-5PM PST.

NO OT, Holidays or weekends

Work Arrangement: Remote

Position Summary:

Performs medical necessity and clinical reviews of authorization requests to determine the medical appropriateness of care in accordance with regulatory guidelines and criteria

Background & Context:

Diverse, supporting team. Key projects for turn around time
Weekly overview team meetings CAMERA ON (professional environment and attire)
Monthly 1on1 meet CAMERA ON
Group chat on teams for any questions

Key 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
Performs other duties as assigned
Complies with all policies and standards
Required to review and process PA for all LOB for . Which includes processing letters

Qualification & Experience:

Required: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.
Required: RN CA licensure required
Years of experience required: 2-3 years of clinical experience. UM a plus,
Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.
Disqualifiers: Not having a CA RN license, No long pauses in recent work history,
Additional qualities to look for:
1 Critical thinking / Independent work
2 Organization / multitasking skills
3 Microsoft Office Suite product knowledge (Teams, one note, excel and word) / tech savvy

Candidate Requirements
Required: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.	Preferred:
Required: RN CA licensure required	Preferred:
Years of experience required: 2-3 years of clinical experience. UM a plus, Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. Disqualifiers: Not having a CA RN license, No long pauses in recent work history, Additional qualities to look for:
Top 3 must-have hard skills stack-ranked by importance	1	Critical thinking / Independent work
2	Organization / multitasking skills
3	Microsoft Office Suite product knowledge (Teams, one note, excel and word) / tech savvy