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. This role is fully remote with possible occasional travel may be required to Charlestown, Massachusetts. Prior Authorization Clinician (REMOTE) Responsibilities • Review inpatient and outpatient services for medical necessity using InterQual 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. Prior Authorization Clinician (REMOTE) Qualifications • 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 InterQual. • 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. Compensation: (DOE)VanderHouwen Contractors Enjoy Exceptional Benefit Perks! As an eligible contract employee with VanderHouwen, 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. Meet VanderHouwen What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we're in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies' staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals. VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career! VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen 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.