Remote Clinical Review Nurse

About the role

We are seeking experienced Registered Nurses (RNs) to join a remote Prior Authorization team supporting Dual Eligible (Medicare and Medicaid) populations. In this role, you will review outpatient authorization requests, assess medical necessity, apply clinical guidelines, and ensure members receive timely and appropriate access to care. You will work collaboratively with providers, medical directors, and interdisciplinary teams while helping maintain high-quality, cost-effective healthcare services.

This is a remote position, ideal for those who thrive in a fast-paced environment. The role involves working collaboratively with a team of healthcare professionals to ensure high-quality, cost-effective healthcare services. The work requires the use of health management systems and adherence to regulatory guidelines.

This is a Contract to Hire position based out of Sunrise, FL.

This position is anticipated to close on Oct 8, 2026.

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 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

Responsibilities

• Perform medical necessity and clinical reviews of authorization requests to determine the medical appropriateness of care in accordance with regulatory guidelines and criteria.
• Collaborate with healthcare providers and the authorization team to ensure timely review of services and/or requests, ensuring members receive authorized care.
• Coordinate with healthcare providers and interdepartmental teams to assess the medical necessity of care for members.
• Escalate prior authorization requests to