Prior Authorization Clinician (Remote) in Boston, Massachusetts - #71937 | VanderHouwen

Description

Job Id: 71937

Prior Authorization Clinician (Remote)
Our client is seeking a detail-oriented and clinically strong Prior Authorization Clinician to support utilization review and care coordination in a fully remote environment. This role is ideal for a nurse who combines critical thinking with sound clinical judgment, thrives in a fast-paced setting, and communicates effectively with both providers and internal teams. The ideal candidate is highly organized, adaptable, and committed to ensuring timely, appropriate care decisions that improve member outcomes.

This role is fully remote. Applicants may be required to occasionally travel to Boston, Massachusetts for meetings.

Prior Authorization Clinician (Remote) Responsibilities

• Conduct utilization reviews (pre-certification, concurrent, and retrospective) to assess medical necessity using evidence-based guidelines.
• Evaluate inpatient and outpatient service requests to ensure appropriate, efficient, and timely care delivery.
• Document review determinations, communications, and case activity in compliance with regulatory and internal standards.
• Collaborate with providers and escalate cases to physician reviewers when criteria are not met or additional review is required.
• Support team effectiveness by mentoring peers, participating in audits or meetings, and identifying process improvement opportunities.

Prior Authorization Clinician (Remote) Qualifications

• Active, unrestricted RN license in state of residence.
• 2+ years of prior authorization or utilization review experience using evidence-based criteria (e.g., InterQual).
• Strong clinical judgment and critical thinking skills to evaluate complex cases and determine appropriate levels of care.
• Experience within a managed care environment and familiarity with Medicare and Medicaid guidelines preferred.
• Ability to work independently in a remote setting while meeting strict turnaround times and regulatory requirements.

Compensation: (DOE)

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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.

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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!

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