Prior Authorization Clinician; REMOTE

Prior Authorization Clinician (REMOTE)

Our client is seeking a compassionate and detail-oriented Prior Authorization Clinician to ensure members receive timely, medically appropriate care. The ideal candidate blends clinical expertise with sound judgment, excels in communication and collaboration, and thrives in a fast-paced, remote environment while upholding quality and compliance standards.

• Review inpatient and outpatient services for medical necessity using Inter Qual criteria and medical policy guidelines.
• Conduct pre-certification, concurrent, and retrospective utilization reviews within mandated turnaround times.
• Communicate determinations clearly and professionally to providers, members, and internal teams.
• Refer complex or non-standard cases to Physician Reviewers and document all case activity accurately.
• Support team development through guidance, audits, and participation in quality improvement initiatives.

• Active, unrestricted RN license (compact or MA/NH preferred); BSN strongly desired.
• Minimum 2 years of prior authorization experience using evidence‑based guidelines such as Inter Qual.
• Background in managed care with solid understanding of Medicare and Medicaid regulations.
• Strong clinical judgment, communication, and analytical skills with the ability to work independently.
• Proficient in Microsoft Office and data management systems; adherence to telecommuting standards required.

(DOE)

Vander Houwen Contractors enjoy exceptional benefit perks! As an eligible contract employee with Vander Houwen, you’ll have access to a full suite of benefits designed with your well‑being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short‑ and long‑term disability, and a matching 401(k) to help secure your future.

Vander Houwen is an award‑winning, Women & Diversity‑Owned, WBENC certified professional staffing firm. Founded in 1987, Vander Houwen places experienced professionals across the nation! Our recruitment teams specialize in Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career.

Vander Houwen is an Equal Opportunity Employer and participates in E‑Verify. Vander Houwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.