Actalent is hiring for a REMOTE Utilization Review Nurse
Job Description:
Responsible for the day to day management of health confined plan members in acute care and/or rehabilitative facilities.
Actively monitors the appropriateness of care received by plan members in a variety of settings, acute hospital, sub-acute hospital, and acute rehabilitation facility.
Applies member benefit and medical criteria to determine authorization of services in coordination with the Medical Directors.
Proactively initiates discharge planning for of members, including identification of post-discharge needs and coordination of post discharge referrals/services.
Communicates verbally and in writing authorization and/or denial of covered services with providers, facilities and members.
Qualifications:
Knowledge and use of Proficiency using InterQual and/or Milliman criteria software systems
Minimum of 5 years of Acute Care Nursing experience.
Utilization review experience of at least two years.
Day Shift: M-F from 8am-5pm
FULLY REMOTE - Equipment is provided.
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 [email protected] (%[email protected]) for other accommodation options.