Job Title: Utilization Management Nurse

Job Description

We are seeking a dedicated and detail-oriented Utilization Management Nurse to oversee and review both handwritten and computer-generated medical documents. The role involves ensuring medical necessity for inpatient stays, managing authorizations, and effectively communicating with the Utilization Management department at hospitals.

Responsibilities

• Review handwritten and computer-generated medical documents.
• Prioritize tasks effectively to manage workload.
• Send cases to a medical director for review if criteria do not meet medical necessity for inpatient stays.
• Follow up with the Utilization Management department at hospitals by phone or fax to offer peer-to-peer reviews before sending official denials.
• Complete authorization reviews within a one business day turnaround time.
• Handle approximately 12-20 authorizations per day.
• Manage a mixture of new and concurrent reviews.

Essential Skills

• Active TX RN License
• Experience in Utilization Management and Concurrent Review
• Strong communication skills
• Strong computer and documentation skills

Additional Skills & Qualifications

• Experience in managed care is preferred

Work Environment

This is a full remote work-from-home position. The working hours are Monday through Friday from 8:00am to 5:00pm. The dress code is business casual. If given the opportunity to transition to a permanent role, you will enjoy great employee benefits including competitive pay, health, vision and dental benefits, life insurance, tuition reimbursement, a 401(k) retirement program, an employee stock purchase program, generous paid time off, flexible spending accounts, and a wellness program.

Pay and Benefits

The pay range for this position is $35.00 - $39.00/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 28, 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 - $39