Prior Authorization Nurse, LVN

Wheeler Staffing Partners is a professional staffing firm that connects skilled professionals with top employers across the country. We are committed to supporting healthcare providers and organizations with high-quality staffing solutions.

Job Title: Prior Authorization Nurse (LVN/RN – California License) Employment Type: Contract Location: Fully Remote Schedule: Monday – Friday | 8:00 AM – 5:00 PM PST Pay Rate: $30 – $34 per hour License Requirement: Active LVN or RN License (California) Job Summary: Wheeler Staffing Partners is hiring a Prior Authorization Nurse for a fully remote contract position. This role supports medical management functions by reviewing, screening, coordinating, and processing referrals for medical services. The nurse will utilize review criteria, policies, and guidelines to ensure appropriate, cost-effective, and high-quality care is delivered to members in the correct setting.

Process referral determinations using Milliman Care Guidelines Identify and refer complex cases to medical director Ensure accurate coding and letter documentation (denials, deferrals, modifications) Select appropriate, contracted providers Verify member eligibility and health plan benefits Route records and trigger appropriate determination notices Maintain compliance with turnaround time standards (ICE TAT) Meet or exceed quality and productivity standards Collaborate with providers and medical directors Identify and refer members to case management or disease management programs Attend required training and team meetings Maintain confidentiality of records and documentation Communicate and collaborate across internal departments