Authorization Specialist Job Description The Authorization Specialist will perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines and clinical criteria. The role involves collaboration with healthcare providers and the authorization team to ensure timely review and approval of services. Responsibilities + Perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines and clinical criteria. + Collaborate with healthcare providers and the authorization team to ensure timely review and approval of services. + Coordinate with interdepartmental teams and providers to assess and validate the medical necessity of care. + Escalate complex or questionable cases to Medical Directors for further review. + Support service authorization for member transfers or discharge planning to facilitate timely transitions between care levels or facilities. + Accurately document and maintain clinical information in health management systems to ensure compliance. + Educate providers and internal teams on utilization processes to promote high-quality, cost-effective care. + 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 Skills + Utilization management + Prior authorization + Utilization review + Clinical review + Patient care + Licensed registered nurse Additional Skills & Qualifications + Graduate 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 position is remote, based in Ohio, with working hours from 8 AM to 5 PM. No overtime is required. Pay and Benefits The 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 18, 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 (%20actalentaccommodation@actalentservices.com) for other accommodation options.