Actively looking to hire multiple RNs to join a growing 3rd party provider on the post acute utilization review team! This role is looking to have nurses start for July 8th ! The schedule for this role is Tuesday to Saturday 9am EST to 6PM MST. PTO and benefits offered! Must have at least 2 years of experience working within utilization review. Interviews are being set up quickly! Apply today!

Duties:

• Perform an initial evaluation of the referral appropriateness for services.
• Review for information needed to make a medical necessity determination.
• Request additional clinical information when needed to render a decision and determine next steps.
• Use clinical expertise, review clinical information and clinical criteria (e.g., CMS, MCGs, Interqual) to determine if the service/device meet medical necessity for the patient.
• Ensure case review and elevation to complete the determination is rendered within the contractual and regulatory turnaround time standards to meet both contractual and regulatory requirements.
• Interact with the Medical Director as needed to ensure proper medical necessity decisions are being made in a timely manner.
• Develops/maintains a working knowledge of all services/guidelines/policies and accesses contract information, including the terms of the contract as appropriate

Qualifications:

• 2 years of Utilization Review Experience
• Active RN License
• Experience working in the managed care setting

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.