Job Description
This role involves analyzing prior authorization requests to assess the medical necessity of services and the appropriate level of care according to national standards and contractual requirements. The successful candidate will provide recommendations to medical teams to ensure quality and cost-effectiveness in medical care.
ResponsibilitiesPerform medical necessity and clinical reviews of authorization requests to determine the appropriateness of care following regulatory guidelines and criteria.Collaborate with healthcare providers and authorization teams for timely review of services, including requests related to members.Coordinate with healthcare providers and interdepartmental teams to assess medical necessity for member care.Escalate prior authorization requests to Medical Directors when necessary to determine care appropriateness.Assist with service authorization requests concerning a member’s transfer or discharge plans, ensuring timely discharge between care levels and facilities.Collect, document, and maintain members' clinical information in health management systems to comply with regulatory guidelines.Provide education to providers and interdepartmental teams on utilization processes to encourage high-quality and cost-effective care.Offer feedback to improve the authorization review process for members.Comply with all policies and standards.Essential SkillsClinical review experiencePrior authorization expertiseLicensed Practical Nurse (LPN) or Registered Nurse (RN) certification2-4 years of prior authorization experienceGraduate from an Accredited School of Nursing or a Bachelor's degree in Nursing (BSN)Washington State RN or LPN licenseElectronic Health Portal-based usageTime management skillsAttention to detailAdditional Skills & QualificationsKnowledge of Medicare and Medicaid regulationsFamiliarity with utilization management processesTrue care experience is a plusClinical knowledge and ability to analyze authorization requestsWork Environment
This position is 100% remote, with a schedule of Monday through Sunday from either 6am-2pm or 8am-5pm PST. Candidates must work at least one weekend day per week, with weekday days off not being Friday or Monday. If productivity is met, the option to transition to a 10-hour shift, including a weekend day, is available. The training schedule is Monday to Friday, 8AM-5PM PST for a three-week course with no time off allowed, and cameras are required to be on. There is potential for extension or conversion to a full-time position.
Pay and Benefits
The pay range for this position is $28.00 - $38.00/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 Aug 16, 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 for other accommodation options.