Nursing Graduate Clinical Specialist

Job Summary

Reviewing clinical documentation and managing authorization requests, the full-time Nursing Graduate Clinical Specialist will work remotely to ensure accuracy and compliance while meeting productivity targets in a structured environment.

Key responsibilities

• Review clinical documentation for completeness and medical necessity to support authorization and utilization review workflows
• Apply clinical judgment to prior authorization requests while adhering to established review criteria
• Document findings and maintain compliance with HIPAA and internal quality standards

Required qualifications

• A completed nursing degree
• Experience in a healthcare BPO or hybrid clinical-operations role
• Familiarity with EHR/EMR systems and payer portals
• Ability to navigate high-volume queues and meet productivity expectations
• Understanding of HIPAA and payer requirements