Clinical Review Nurse - Prior Authorization - J00927

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.

Join our dynamic team as a Registered Nurse in a brand new duals program for 2026, where you will manage both Medicare and Medicaid requirements. This program is currently active in eight states and may expand in 2027. You will be responsible for handling outpatient prior authorizations with a focus on clinical review and utilization management.

Manage both Medicare and Medicaid requirements simultaneously. Handle outpatient prior authorization, averaging 1.85 cases per hour. Conduct clinical reviews, utilization management, and concurrent reviews. Engage in medical management and managed care activities. Perform discharge planning and case management. Utilize InterQual for decision-making processes.