Clinical Review Nurse

Job Title : Clinical Review Nurse - Prior Authorization

Location : Remote (this position is looking for east coast nurses who would be willing to help out the PST team on a remote short term contract)

Contract Duration : 3 months

Schedule : Monday-Friday, 8 : 00 AM-5 : 00 PM PST (occasional weekend / holiday rotation)

Position Summary

The Clinical Review Nurse will conduct medical necessity reviews for prior authorization and inpatient service requests, ensuring compliance with Medicaid guidelines and promoting high-quality, cost-effective care. This role supports the Trillium Medicaid Plan and operates within a collaborative but independently driven team.

Key Responsibilities

• Review prior authorization (PA) and inpatient (IP) requests for medical necessity using national standards and regulatory criteria
• Escalate complex cases to Medical Directors for further evaluation
• Coordinate with providers and internal teams to support timely discharge planning and transitions between care levels
• Document clinical decisions and maintain accurate records in health management systems
• Educate providers and internal teams on utilization processes and coverage policies
• Identify opportunities to improve authorization workflows and member experience
• Maintain compliance with OSHA, HIPAA, and Centene standards
• Complete up to 20 authorization reviews per day
• Participate in team huddles and contribute to a supportive, all-hands-on-deck culture

Required Qualifications

Preferred Qualifications

Team Culture & Work Environment

Pay and Benefits

The pay range for this position is $35.00 - $40.00 / 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 :

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Nov 11, 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.