Clinical Review Nurse - Prior Authorization

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Actalent. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. Job Title: Registered Nurse (RN) \- Utilization ManagementJob 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 InterQual 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 InterQual. * 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 Raleigh, NC. 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. Application Deadline 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 actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options. If you have questions about this posting, please contact support@lensa.com