What are the responsibilities and job description for the Prior Authorization Nurse position at Actalent?
Prior Authorization RN
FULLY REMOTE- MUST reside in California
Great opportunity to work with a not-for-profit health plan committed to providing affordable and accessible healthcare to all Californians!
Job Description
The Prior Authorization Nurse will triage and review cases as necessary, handling prior authorization cases in accordance with medical policy and utilizing available resources. The role involves reviewing all prior authorizations for the PPO side.
Responsibilities
- Triage and review cases as needed.
- Work on prior authorization cases following medical policy.
- Utilize resources effectively to manage cases.
- Review all prior authorizations for the PPO side.
Essential Skills
- Strong computer skills.
- Excellent communication skills.
- Experience in utilization review, utilization management, prior authorization, case management, health plan, and/or other managed care
- CA Nursing License.
- Experience with electronic medical records (EMR).
Additional Skills & Qualifications
- Minimum of 3 years of experience, with some flexibility.
- Bachelor of Science in Nursing (BSN) preferred.
- Experience with MS applications.
- Experience in managed care or health plan environments.
Work Environment
This position is fully remote, with a typical schedule of Monday through Friday, 8 AM to 5 PM. Candidates must be open to visiting the nearest office if necessary, though this is rare and usually due to internet or IT issues
Job Type & LocationThis is a Contract to Hire position based out of Rancho Cordova, CA.
Pay and BenefitsThe pay range for this position is $40.00 - $50.00/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 TypeThis is a hybrid position in Rancho Cordova,CA.
Application DeadlineThis position is anticipated to close on Dec 12, 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.
Salary : $40 - $50