Remote Optum Prior Authorization Jobs in Nevada (NOW HIRING)

**EXTERNAL CANDIDATES ONLY**
Rural Health Group, a Federally Qualified Health Center in northeastern North Carolina, is seeking a Registered Nurse (RN) to fill a full-time or part-time position (20 hours per week) as an Ambulatory Nurse in our Henderson location.  Remote options are also available. 
The Ambulatory Nurse is responsible for supporting patient care through the efficient management of clinical documentation, laboratory results, medication refill requests, patient communications, prior authorization coordination, and document management. This role serves as a key liaison between patients, providers, pharmacies, insurance companies, and other healthcare team members to ensure timely, accurate, and compassionate care while supporting and coordinating care for multiple providers within the practice.

A primary goal of this position is to reduce provider inbox burden by independently managing appropriate clinical workflows, coordinating patient care, and resolving complex clinical and administrative issues within established protocols. This position is not intended to function as an additional clinical assistant but rather as a licensed clinical resource that improves provider efficiency and continuity of patient care.

• Respond to incoming patient phone calls, portal messages, and clinical inquiries.
• Assess patient concerns and route urgent issues to the appropriate provider.
• Provide patient education regarding medications, treatment plans, and follow-up care.
• Document all patient interactions accurately in the electronic health record (EHR).
• Process prescription refill requests according to established protocols.
• Review refill eligibility, medication history, and provider instructions.
• Coordinate with pharmacies regarding prescription clarifications.
• Investigate and resolve medication access issues, including prior authorization barriers, insurance denials, formulary restrictions, and unavailable medications.
• Review incoming laboratory and diagnostic reports.
• Communicate normal and provider-reviewed results to patients.
• Coordinate follow-up testing and appointments when indicated.
• Track outstanding results and ensure provider review.
• Maintain a tracking system for high-risk and abnormal test results, ensuring timely follow-up, provider escalation, patient communication, and documentation of outcomes.
• Manage and maintain patient records within the EHR system.
• Complete clinical forms and medical documentation.
• Support providers with patient care coordination and workflow management.
• Monitor patient follow-up needs and identify care gaps.

1. Good Judgment
2. Communication/Customer Service/Teamwork
3. Passion
4. Honesty
5. Responsibility
6. Job-Specific Skill Set

Education, Licensure & Experience:

• Current NC Registered Nurse (RN) licensure in good standing is required
• Minimum two (2) years of experience as nurse, in outpatient, community/health, critical care or emergency care
• Experience using electronic health records (EHR). Must be able to quickly learn to use eClinicalWorks electronic health record system
• Experience with care coordination for the following populations is preferred: uninsured or underserved patients and patients with substance abuse disorders.
• Experience in primary care, family practice, occupational health or ambulatory care preferred.
• Strong communication, organizational, and problem-solving skills is required.
• Ability to manage multiple priorities in a fast-paced environment is required.
• Demonstrated ability to work independently with minimal supervision while exercising sound clinical judgment and adhering to established protocols, policies, and regulatory requirements is required.
• Bilingual (English/Spanish) is a plus, but not required; applicants who may serve in a translating capacity will be required to take a language assessment

EOE. Federal and State Criminal Background Checks and Drug Screen required for all positions. Influenza vaccine is also a condition of employment.
E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.