Job Description
We are seeking a dedicated Authorization Nurse to perform medical necessity and clinical reviews of authorization requests in compliance with regulatory guidelines and clinical criteria. The ideal candidate will collaborate with healthcare providers and the authorization team to ensure timely review and approval of services.
ResponsibilitiesPerform medical necessity and clinical reviews of authorization requests.Collaborate with healthcare providers and the authorization team.Coordinate with interdepartmental teams to assess and validate medical necessity.Escalate complex cases to Medical Directors for further review.Support service authorization for member transfers or discharge planning.Accurately document and maintain clinical information in health management systems.Educate providers and internal teams on utilization processes.Identify and share opportunities for process improvement in the authorization review workflow.Perform other duties as assigned.Comply with all organizational policies and standards.Essential SkillsExperience in utilization management, prior authorization, and utilization review.Clinical review and patient care skills.Must be a licensed registered nurse.Additional Skills & QualificationsGraduate from an Accredited School of Nursing or Bachelor's degree in Nursing.2 - 4 years of related experience.Knowledge of NCQA, Medicare, and Medicaid regulations preferred.Knowledge of utilization management processes preferred.LPN - Licensed Practical Nurse - State Licensure required OR RN - Registered Nurse - State Licensure and/or Compact State Licensure required.Work Environment
This is a remote position based in Ohio, with working hours from 8 AM to 5 PM. No overtime is required. The role allows engagement with members to address overall care and coverage issues.
Pay and BenefitsThe pay range for this position is $36.00 - $44.00/hr.
Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Jun 27, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.