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Clinical Review Nurse (Utilization Management)100% Remote
Job Description
The role of the Utilization Management Nurse involves performing concurrent reviews, determining the member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. You will assist in evaluating inpatient services to validate the necessity and setting of care being delivered to the member.
Responsibilities
- Perform concurrent reviews to assess member's overall health.
- Review the type of care being delivered and evaluate medical necessity.
- Contribute to discharge planning according to established care policies and guidelines.
- Assist in evaluating inpatient services to ensure the necessity and appropriate setting of care.
Essential Skills
- 2+ years of utilization management and utilization review expertise.
- Experience in concurrent review and prior authorization.
- Knowledge in managed care and patient care.
Additional Skills & Qualifications
- Bachelor's or Associate's degree in Nursing.
- Compact/Multistate Nursing License.
- Strong multitasking and time management abilities.
- Quick learning and adaptable attitude.
- Computer savvy.
Work Environment
This position is fully remote. Candidates can be located anywhere within Central or Eastern Time zones
Pay and Benefits
The pay range for this position is $35.00 - $40.00/hr.
Requirements
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 Aug 20, 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
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If you have questions about this posting, please contact
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