Prior Authorization Clinician job at VanderHouwen in Boston, MA

Prior Authorization Clinician (REMOTE) in Boston, Massachusetts - #70738 | VanderHouwen Location Boston, Massachusetts Type Contract Description Job Id: 70738 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.