Clinical Review Nurse

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: Clinical Review Nurse – Prior AuthorizationLocation: 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 monthsSchedule: Monday–Friday, 8:00 AM–5:00 PM PST (occasional weekend/holiday rotation)Position SummaryThe 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 ResponsibilitiesReview 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 QualificationsActive RN or LPN license Minimum 2 years of prior authorization or inpatient review experience with a health plan or insurance company Strong clinical judgment and understanding of medical necessity criteria Familiarity with Medicaid regulations and utilization management processes Ability to work independently while contributing to a collaborative team Willingness to work one weekend per month and occasional holidays Preferred QualificationsExperience with Trillium Plan or Oregon Medicaid Positive attitude and eagerness to learn Proficiency with EMR systems and clinical documentation platforms Team Culture & Work EnvironmentFriendly, welcoming team that values collaboration and independence Remote-first environment with structured onboarding and training “One for all, all for one” mindset — everyone contributes to shared goals No possibility of extension or conversion; focused short-term engagement Pay and BenefitsThe pay range for this position is $35.00 - $40.00/hr.RequirementsEligibility 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 TypeThis is a fully remote position.Application DeadlineThis position is anticipated to close on Nov 11, 2025.About ActalentActalent 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