Job Title: Post Review Nurse - Utilization Management

We are seeking a diligent and detail-oriented Post Review Nurse to perform timely utilization management reviews and claims assessments. This role involves applying InterQual criteria and medical policy to evaluate medical records and determine medical necessity. You will collaborate with internal care management teams to ensure member needs are met and contribute to the overall efficiency and quality of our healthcare services.

Responsibilities

• Conduct utilization management reviews and claims assessments using InterQual criteria and medical policy.
• Review medical records for suspended claims and provider inquiries to determine medical necessity.
• Collaborate with internal care management teams to meet member needs.
• Meet production metrics, completing a minimum of 40 reviews per day post-training, and maintain quality assurance standards at 97%.
• Document reviews accurately and consistently in Frontier and internal systems.
• Apply clinical criteria and benefit information to support medical review decisions.
• Ensure compliance with URAC, NCQA, HIPAA, and internal guidelines.
• Participate in cross-functional collaboration across divisions.
• Provide backup support to other UM teams, including precertification and continued stay reviews.
• Facilitate discharge planning and transition of care in collaboration with facilities and members.
• Perform other duties as assigned.

• Utilization management and utilization review experience.
• Acute care expertise.
• Knowledge of HIPAA, ICD, and CPT.
• Completion of an accredited RN or LPN program.
• Active, unrestricted RN or LPN license in Iowa or South Dakota.
• 4 years of clinical experience in acute or outpatient settings.
• Familiarity with ICD9-CM, HCPC, and CPT coding systems.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication.
• Attention to detail and ability to assess patient conditions via medical record review.
• Proficiency in electronic charting and Microsoft Office.
• Knowledge of URAC, NCQA, HIPAA, and PHI standards.
• Ability to work independently and make decisions under ambiguity.
• Strong organizational skills and ability to manage multiple priorities.
• Collaborative mindset and professionalism in stakeholder interactions.
• Quick learner with strong technical acumen.

• Experience in discharge planning and transition of care.
• Experience working remotely and managing a home office setup.
• Proficiency in using Frontier system.

This role is fully remote, allowing you the flexibility to work from a location where you are most productive. Candidates located in Iowa or South Dakota are preferred, and a high-speed internet connection is required. The position involves standard working hours from 8:00 AM to 5:00 PM CST. While the role is remote, there may be occasional requests to attend meetings or events in the office. Training will be provided over 2-3 weeks with buddy support and ongoing guidance. The role is expected to last at least 6 months, likely extending through the end of 2025.

Job Type & Location

This is a Contract position based out of Des Moines, Iowa.

Pay and Benefits

The pay range for this position is $35.00 - $40.00/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 Sep 17, 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.

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 : $35 - $40