Clinical Review Nurse

Description

•\tReviewing authorization requests

•\tUtilizing evidence-based criteria and making a medically necessary determination.

•\tOutreach calls to providers to request additional details if applicable.

•\tThey will not be completing any calls to members.

•\tCase management experience is not what the team is looking for, even though they work with this team. Looking for a candidate who has experience in utilization review nurse, or prior authorization nurse.

Skills

clinical review, case management, rn license, medical, claim

Top Skills Details

clinical review,case management,rn license,medical,claim

Additional Skills & Qualifications

RN or LPN, RN is highly preferred

Required: Experience utilizing MCG and InterQual evidence based criteria as well as CMS Guidelines (LCA, LCD, NCD) .

Utilization Review (Prior Authorization)

Medicare experience ( Utilization Management with Medicare)

ICU, Medical Surgical experience, bedside experience (Home health nurses)

Acute Care

Experience Level

Expert Level

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 Aug 18, 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.