Prior Authorization Nurse (Remote - Oregon Only)

Prior Authorization Nurse (Remote - Oregon Only) Pay: $38–$43/hour (based on experience) Schedule: Monday–Friday, 8:00 AM – 5:00 PM PST Contract Length: Starts ASAP, Scheduled end is 02/28/2026 Location: Fully Remote (Must reside in Oregon) About the Role A-Line Staffing is seeking an experienced Prior Authorization Nurse (RN or LPN). In this role, you’ll analyze prior authorization requests to determine medical necessity, appropriate level of care, and benefit coverage. You’ll work closely with medical directors, providers, and interdepartmental teams to ensure quality, cost-effective care for members. Key Responsibilities • Review prior authorization requests to determine medical necessity and clinical appropriateness in alignment with regulatory guidelines and clinical criteria. • Collaborate with healthcare providers and internal teams to ensure timely review and authorization of services. • Escalate complex cases to Medical Directors as needed for further evaluation. • Coordinate discharge and transfer plans to ensure seamless care transitions. • Accurately document and maintain clinical information in health management systems to ensure compliance with Medicare, Medicaid, and organizational standards. • Provide education and support to providers and internal departments regarding utilization review processes. • Identify and recommend process improvements to enhance efficiency and member experience. • Perform other related duties as assigned. Qualifications Required: • Active RN or LPN license in Oregon • 2+ years of prior authorization experience • Graduate of an accredited School of Nursing (ASN or BSN) • Strong clinical assessment and analytical skills Preferred: • Knowledge of Medicare and Medicaid regulations • Experience in utilization management and medical review processes If you are interested in this role, feel free to reach out to [email protected] or apply to this posting! Apply tot his job