Clinical Review Nurse - Prior Authorization

Location: Remote from anywhere within the state of Missouri, United States. Monday–Friday, 8:00 a.m.–5:00 p.m.

Salary: $27.02–$48.55 per hour

Company

hirify.global provides healthcare services focused on improving access to effective and affordable care for individuals, families, and communities.

What you will do

• Review medical and behavioral health prior authorization requests to determine medical necessity, clinical appropriateness, and the appropriate level of care.
• Apply regulatory guidelines, national standards, contractual requirements, and member benefit coverage criteria.
• Coordinate with healthcare providers, authorization teams, and interdepartmental groups to support timely service approvals.
• Escalate appropriate requests to Medical Directors and assist with transfer and discharge authorization plans.
• Document and maintain member clinical information in health management systems.
• Educate providers and internal teams on utilization processes and identify opportunities to improve authorization reviews.

Requirements

• Graduate of an accredited school of nursing or a bachelor's degree in nursing.
• 2–4 years of related experience.
• Current LPN state licensure is required.
• Clinical knowledge and the ability to analyze authorization requests and determine medical necessity.
• Knowledge of Medicare, Medicaid, and utilization management processes is preferred.
• Applicants must be able to work remotely from within Missouri.

Culture & Benefits

• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible work arrangements are available across remote, hybrid, field, and office roles.
• Work focused on improving healthcare access and outcomes for foster care members.
• Equal opportunity employment and consideration for qualified applicants with arrest or conviction records in accordance with applicable law.