Utilization Nurse

Job Title: Utilization Management Nurse

Location: Remote

Position Overview

The Utilization Management Nurse is responsible for reviewing inpatient admissions and applying nationally recognized medical necessity criteria to determine appropriate levels of care. This role supports members through admission, concurrent review, and discharge planning processes. The nurse will report to the Utilization Management Nurse Manager and work collaboratively with healthcare teams to ensure quality, cost-effective care.

Key Responsibilities

• Review inpatient admissions using established guidelines (e.g., MCG Criteria) to determine medical necessity
• Perform concurrent reviews of clinical documentation submitted by facilities
• Manage assigned member caseloads based on alphabetical distribution
• Coordinate discharge planning, care transitions, and transfers to higher levels of care when necessary
• Collaborate with providers, facilities, and internal teams to support appropriate care decisions
• Identify and manage out-of-network admissions as needed
• Maintain accurate documentation in EMR systems
• Ensure compliance with regulatory and organizational standards

Required Skills

• Acute care and inpatient care experience
• Utilization management and utilization review experience
• Concurrent review experience
• Strong computer and EMR navigation skills
• Excellent communication skills (written and verbal)
• Ability to work independently in a remote environment

Qualifications

• Active California RN License (required)
• Bachelor of Science in Nursing (BSN) or advanced degree preferred
• Minimum of 5 years of relevant clinical experience
• Strong organizational and time management skills
• Self-motivated with the ability to work independently
• Demonstrated teamwork and collaboration skills

Job Type & Location

This is a Contract to Hire position based out of Rancho Cordova, CA.

The pay range for this position is $45.00 - $50.00/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 May 22, 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 process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

Salary : $45 - $50