Hiring for Utilization Review Nurse

Job Description

As a Utilization Review Nurse, you will ensure the quality and continuity of care for our members by reviewing acuity levels, resource consumption, length of stay, and discharge planning. You will work closely with Medical Affairs and Medical Directors to discuss member care and provide necessary education to healthcare providers on utilization processes.

Responsibilities

• Review quality and continuity of care by assessing acuity levels, resource consumption, length of stay, and discharge planning.
• Collaborate with Medical Affairs and Medical Directors to discuss and improve member care.
• Document and maintain concurrent review findings, discharge plans, and actions taken in health management systems according to utilization management policies.
• Approve medical determinations or provide recommendations based on requested services and concurrent review findings.
• Educate providers on utilization processes to ensure high-quality, appropriate care.
• Provide feedback to leadership on opportunities to improve care levels and medical necessity based on clinical policies.
• Review members' transfer or discharge plans to ensure timely transitions between care levels and facilities.
• Collaborate with care management on member referrals as appropriate.
• Perform other duties as assigned and comply with all policies and standards.

Additional Skills & Qualifications

• UM experience is teachable and not mandatory.
• General typing skills.

Work Environment

This is a fully remote position with working hours from Monday to Friday, 8 AM to 5 PM.

Pay and Benefits

The pay range for this position is $35.00 - $36.00/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 Feb 5, 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.

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 actalentaccommodation@actalentservices.com for other accommodation options.

Salary : $35 - $36