Clinical Review Nurse - Prior Authorization

at Actalent in Newark, Delaware, United States

Job Description


Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards contractual requirements and a member’s benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

Must Haves:

2-4 years of related experience

Graduate from an Accredited School of Nursing or Bachelors degree in Nursing

LPN License – DE or Compact license required.

Prior Authorization Experience required.

Experience in InterQual Milliman

Understanding State Policies


Prior Authorization, Clinical review, Licensed Practical Nurse, LPN, Interqual

Additional Skills & Qualifications:

Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.

Knowledge of Medicare and Medicaid regulations preferred.

Knowledge of Medicare and Medicaid regulations preferred.

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.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

+ Hiring diverse talent

+ Maintaining an inclusive environment through persistent self-reflection

+ Building a culture of care, engagement, and recognition with clear outcomes

+ Ensuring growth opportunities for our people

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 process due to a disability, please email ( for other accommodation options.

Copy Link

Job Posting: JC258447347

Posted On: Apr 17, 2024

Updated On: Apr 25, 2024

Please Wait ...