Actively looking to hire multiple RNs to join a large health plan on a remote basis working on DME reviews. This is a Monday to Friday; no weekends or holidays! Must have at least 2 years of utilization review experience and discharge planning experience! This is an URGENT need and will move quickly! This is a 6 month contract with the potential to get extended!

Apply today!

• Will provide service and support to members and health care providers- including pre-service reviews, out of network referrals and support for Health Plan
• Will be working primary on prior authorizations specifically with Diagnostic Images (MRI's, CTs, etc.) at the beginning but could eventually be handling additional prior authorizations as needed
• Utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical criteria (InterQual) and benefit information
• Provide consultation and responses to utilization management requests
• May complete medical reviews any apply utilization review criteria for patient admissions and various levels of care, continued stay reviews, and/or discharge planning
• All reviews will be done in the component content management system (CCMS- internal database) but could interact directly with providers via email or phone for clinical or urgent denial requests
• Establishes relationships and effectively engages with members and providers through telephonic communication; obtains necessary information and facilitates care in multiple settings
• Responsible for minimum of 25 reviews a day with a 97% QA review.

Qualifications:

• Completion of an accredited registered nursing program
• Must have a Compact License if they are not living in Iowa or South Dakota. Will consider LPNs, but RNs are highly preferred.
• 4 years of diverse clinical experience (e.g., critical care, acute care, outpatient) with direct clinical care to the consumer. Acute Care, Home Health and Med Surg experience preferred/ideal. Looking for candidates with a lot of breadth vs depth in one area of focus.
• 2 years of Utilization Review Experience

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.