Utilization Review Nurse

About the Role

We’re looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, cost‑effective patient care from a fully remote environment. This role is ideal for nurses who enjoy clinical evaluation, structured decision‑making, and collaborating with providers to ensure appropriate levels of care.

Key Responsibilities

• Conduct utilization reviews for inpatient, outpatient, and ancillary services using established clinical criteria
• Assess medical necessity and determine appropriate levels of care
• Document clinical findings accurately within internal systems
• Communicate with providers to obtain additional clinical information when needed
• Support denial management, including appeals and peer‑to‑peer review processes
• Ensure regulatory compliance with payer guidelines and organizational policies
• Identify care coordination needs and refer cases to case management as appropriate

Qualifications

• Active CA RN license in good standing
• 2–3 years of clinical experience in prior authorization, case management, or utilization management
• Familiarity with InterQual or MCG criteria strongly preferred
• Strong critical thinking skills and ability to interpret clinical documentation
• Excellent communication abilities with providers and internal teams
• Comfort with remote technology, EMRs, and digital workflows

Job Type & Location

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

The pay range for this position is $40.00 - $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 hybrid position in Rancho Cordova,CA.

This position is anticipated to close on Jan 6, 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 : $40 - $50