Clinical Review Nurse - Prior Authorization

Job Title:

Registered Nurse (RN) - Utilization Management

Job Description

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.

Responsibilities

+ 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 Inter Qual for decision-making processes.

Essential Skills

+ Registered Nurse (RN) with compact license.

+ Experience in Utilization Management (UM) and outpatient prior authorization.

+ Proficient in clinical review, utilization management, and discharge planning.

+ Strong computer skills.

Additional

Skills & Qualifications

+ Strong preference for experience with Inter Qual.

+ Experience in managed care and medical management.

Work Environment

This role offers flexibility with a start time around 9 or 10 AM, allowing candidates to work in their own time zone. The position requires availability to work as late as 7 PM, with a preference for candidates in the Pacific and Mountain time zones. The role includes approximately 2 weeks of training followed by assignment to a preceptor or mentor.

Job Type & Location

This is a Contract to Hire position based out of St. Louis, MO.

Pay and Benefits

The pay range for this position is $33.00 - $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:

- 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.

Final date to receive applications

This position is anticipated to close on Mar 17, 2026.

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 actalentaccom (%20actalentaccom)  for other accommodation options.