Healthcare Consultant III - RN – Outpatient Prior Authorization
Duration: 6 months contract
Position Overview
The RN – Outpatient Prior Authorization is responsible for reviewing outpatient service requests and determining medical necessity using evidence-based clinical guidelines and organizational policy. This role focuses exclusively on outpatient prior authorizations and ensures accurate, timely, and compliant determinations.
The position will also support a system transition from QNXT to Med Compass, including workflow validation, testing, and stabilization during implementation.
Key Responsibilities
• Review outpatient prior authorization requests and apply appropriate medical necessity criteria (Medicare NCD/LCD, state guidelines, MCG where applicable).
• Analyze and interpret clinical documentation to support accurate determinations.
• Ensure timely and compliant decision-making aligned with federal and state requirements.
• Document review outcomes clearly and maintain audit-ready records.
• Participate in system transition activities (workflow validation, UAT testing, defect identification, process improvements).
• Communicate determination outcomes professionally to providers and internal stakeholders.
• Maintain high productivity and quality standards in a high-volume environment.
Required Qualifications
• Active, unrestricted Compact RN License.
• Associate Degree in Nursing (BSN preferred).
• Minimum 3 years of recent RN clinical experience in:
• Acute Care
• Emergency Department (ED)
• ICU
• Med/Surg
• Telemetry
• Home Health
• Ability to work a full 40-hour week aligned with Arizona time zone (Monday–Friday, 8:30 AM–5:00 PM client time).
• Dedicated, interruption-free home workspace.
Preferred Qualifications
• Prior Authorization or Utilization Management experience.
• Experience applying clinical criteria such as:
• MCG
• InterQual
• Medicare NCD/LCD
• Experience with QNXT, Med Compass, or similar systems.
• Experience supporting system implementations or workflow transitions.
About US Tech Solutions:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Name: Santwana
Email: [email protected]
Internal Id: 26-04537
Job Type: Contract
Pay: $36.00 - $38.00 per hour
Work Location: Remote
Apply Now
Apply Now
Position Overview
The RN – Outpatient Prior Authorization is responsible for reviewing outpatient service requests and determining medical necessity using evidence-based clinical guidelines and organizational policy. This role focuses exclusively on outpatient prior authorizations and ensures accurate, timely, and compliant determinations.
The position will also support a system transition from QNXT to Med Compass, including workflow validation, testing, and stabilization during implementation.
Key Responsibilities
• Review outpatient prior authorization requests and apply appropriate medical necessity criteria (Medicare NCD/LCD, state guidelines, MCG where applicable).
• Analyze and interpret clinical documentation to support accurate determinations.
• Ensure timely and compliant decision-making aligned with federal and state requirements.
• Document review outcomes clearly and maintain audit-ready records.
• Participate in system transition activities (workflow validation, UAT testing, defect identification, process improvements).
• Communicate determination outcomes professionally to providers and internal stakeholders.
• Maintain high productivity and quality standards in a high-volume environment.
Required Qualifications
• Active, unrestricted Compact RN License.
• Associate Degree in Nursing (BSN preferred).
• Minimum 3 years of recent RN clinical experience in:
• Acute Care
• Emergency Department (ED)
• ICU
• Med/Surg
• Telemetry
• Home Health
• Ability to work a full 40-hour week aligned with Arizona time zone (Monday–Friday, 8:30 AM–5:00 PM client time).
• Dedicated, interruption-free home workspace.
Preferred Qualifications
• Prior Authorization or Utilization Management experience.
• Experience applying clinical criteria such as:
• MCG
• InterQual
• Medicare NCD/LCD
• Experience with QNXT, Med Compass, or similar systems.
• Experience supporting system implementations or workflow transitions.
About US Tech Solutions:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Name: Santwana
Email: [email protected]
Internal Id: 26-04537
Job Type: Contract
Pay: $36.00 - $38.00 per hour
Work Location: Remote
Apply Now
Apply Now