Clinical Review Nurse (Remote)

Actalent • Saint Louis, MO • 2h ago

Remote Clinical Review Nurse - Prior Authorization

Location: Must be located in Central or Eastern time zones

Employment Type: Full-Time

About the Role

We are seeking an experienced Registered Nurse to join our team within a leading Managed Care Organization. This role is fully remote and focuses on reviewing clinical documentation to determine medical necessity, appropriateness of care, and alignment with established guidelines.

The ideal candidate brings strong clinical judgment, excellent communication skills, and the ability to work independently in a fast-paced environment.

Key Responsibilities

Conduct clinical reviews of prior authorization requests for medical services, procedures, and medications.

Evaluate clinical documentation to determine medical necessity based on evidence-based criteria and MCO guidelines.

Collaborate with providers, internal teams, and medical directors to gather additional information when needed.

Document all review decisions clearly, accurately, and in compliance with regulatory and organizational standards.

Maintain up-to-date knowledge of clinical guidelines, utilization management policies, and industry best practices.

Support quality improvement initiatives and contribute to process optimization within the UM department.

Required Qualifications

Active Compact RN License (multistate).

5+ years of recent acute care experience in a hospital setting, specifically on ER or ICU floors.

Strong understanding of clinical workflows, medical terminology, and acute care decision-making.

Excellent critical thinking, assessment, and documentation skills.

Ability to work remotely with reliable internet access and a distraction-free workspace.

Comfortable navigating electronic medical records and utilization management systems.

What We Offer

Fully remote work environment.

Competitive compensation and benefits package.

Opportunities for professional growth within a large, mission-driven organization.

Supportive team culture and strong clinical leadership.

Job Type & Location

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

Pay and Benefits

The pay range for this position is $35.00 - $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 Jan 24, 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.

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