Actalent

Clinical Review Nurse (Prior Auth Expr) - Remote

Posted on

July 15, 2025

Job Type

Full-Time

Role Type

Utilization Review

License

RN

State License

Florida

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Help & Resources

Company Description

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.

Job Description

Requirements

3+ Years of experience working with utilization management, concurrent review, prior authorization, utilization review, case management, and discharge planning is Mandatory Active RN License is Mandatory

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Responsibilities

Review approximately 20 cases a day for medical necessity. Advocate for and protect members from unnecessary hospital admissions. Follow established procedures and processes to complete authorizations. Collaborate with a team of nurses to assist each other and complete cases. Communicate with doctors and case managers to make decisions and obtain additional information about members' conditions. Utilize multiple resources to ensure the successful completion of cases.

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