Utilization Management Nurse

Utilization Management Nurse

Job Description

Responsible for reviewing and documenting prior authorization and concurrent stay requests, as well as member case histories, in compliance with policies, procedures, clinical criteria (MCG), and member coverage. This role requires remote interfacing with members, providers, facilities, medical directors, intake staff, case managers, and other departments internally.

Responsibilities

• Review and document prior authorization and concurrent stay requests.
• Evaluate member case history in compliance with policies and procedures, clinical criteria (MCG), and member coverage.
• Interface remotely with members, providers, facilities, medical directors, intake staff, case managers, and other internal departments.
• Determine the medical necessity of post-acute stays using clinical judgment and MCG criteria.
• Route cases to the medical director for denial if the member no longer needs care.

Essential Skills

• Associate or bachelor’s degree in nursing.
• 3-5 years of clinical experience.
• 1 year of previous utilization management experience employed by a Payor/3rd Party Managed Care Organization.
• Active, unrestricted RN license required from any state (must be located in MN/WI but does not need to be licensed there).

Work Environment

This position is a remote role. Hours are Monday through Friday from 8:00 am to 4:30 pm. Comprehensive training includes 2 weeks of hands-on experience with a trainer and ongoing support through Microsoft Teams chat. Equipment provided includes a laptop, two monitors, keyboard, mouse, headset, and docking station.

This is a Contract position based out of Minnetonka, MN.

The pay range for this position is $38.00 - $45.00/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)

This is a fully remote position.

This position is anticipated to close on Feb 23, 2026.

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.

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 due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Salary : $38 - $45