Utilization Review Nurse (LVN) – InpatientPrimary ResponsibilitiesPerform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges.Apply CMS regulations and evidence-based criteria (MCG, InterQual) to evaluate medical necessity.Collaborate with hospital teams, providers, IPA case managers, and health plan representatives.Conduct in-person hospital rounds 2–3 days per week; perform telephonic reviews and participate in interdisciplinary case reviews.Escalate complex or ambiguous cases to the Medical Director or Physician Reviewer.Ensure complete, accurate, and compliant documentation aligned with CMS and Health standards.Monitor daily inpatient census –managed members across contracted hospitals.Support discharge planning and identify post-acute needs (e.g., SNF, rehab, home health, DME).Communicate avoidable days, delays in care, and readmission risks to UM leadership.Participate in audit readiness, quality improvement projects, and performance reporting.Educate providers and facilities on Medicare UM criteria and documentation standards.Perform related duties consistent with the scope and intent of the position.Maintain regular attendance and travel as requiredOther FunctionsMaintain professional demeanor and uphold Health values.Adhere to departmental performance metrics (e.g., turnaround times, quality standards, productivity).Attend educational sessions and training to stay current with Medicare UM requirements and policies.Stay updated through educational opportunities, professional publications, networks, and organizations.Represent the UM department effectively in interdisciplinary team meetings.Maintain IPA and Health Plan compliance standards.Enforce company policies and safety procedures.CompetenciesMinimum 3 years of inpatient hospital nursing experience (e.g., med-surg, telemetry, ICU).At least 1 year of experience in utilization review, case management, or hospital discharge planning preferredFamiliarity with CMS inpatient criteria, including the Two-Midnight Rule.Proficiency in Microsoft Office and EMR systems.Preferred experience with IPA, MSO, or delegated managed care environments.Working knowledge of EZ-CAP, EZ-Net, InterQual, and MCG preferred.Background in concurrent review or inpatient census oversight preferred.Strong critical thinking, communication, and clinical documentation skills.Excellent oral and written communication skills.Strong active listening, analytical, and problem-solving abilities.Ability to multi-task, manage time effectively, and meet deadlines.Professionalism and confidence in engaging providers and members.Ability to provide and receive constructive feedback.Maintain confidentiality and share information appropriately.Consistently deliver excellent customer service.High attention to detail and accurate documentation.Thrive in a dynamic, fast-paced team environment.Commitment to the organization’s mission.Mid-level proficiency in Microsoft Word, Excel, PowerPoint, Visio; Access is a plus.Ability to quickly learn and use new software tools and email applications.Self-motivated with strong organizational and planning skills.Ability to work independently and collaboratively.Education and LicensureGraduate of an accredited school of nursing.MUST have LVN or RN ACTIVE CA LicenseActive and valid California Driver’s License.Travel and ScheduleAbility to travel locally to contracted hospitals and IPA offices (2–3 days/week).Flexibility for early morning hospital visits.Between hours of 7am-5pm
Pay and Benefits

The pay range for this position is $40.00 - $43.00/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 hybrid position in Sacramento,CA.

Application Deadline

This position is anticipated to close on Aug 21, 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.