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100% Remote Utilization Management Nurse
Description
- Reviewing authorization requests
- Utilizing evidence-based criteria and making a medically necessary determination.
- Outreach calls to providers to request additional details if applicable.
- They will not be completing any calls to members.
- Case management experience is not what the team is looking for, even though they work with this team. Please ensure the candidate has a background in utilization review nurse, or prior authorization nurse.
Skills
clinical review, case management, rn license, medical, claim
Top Skills Details
clinical review,case management,rn license,medical,claim
Additional Skills & Qualifications
RN or LPN, RN is highly preferred
Required: Experience utilizing MCG and InterQual evidence based criteria as well as CMS Guidelines (LCA, LCD, NCD) .
Utilization Review (Prior Authorization)
Medicare experience ( Utilization Management with Medicare)
ICU, Medical Surgical background , bedside experience (Home health nurses)
Acute Care
Pay and Benefits
The pay range for this position is $35.00 - $40.00/hr.
Requirements
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 Aug 24, 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 (%20actalentaccommodation@actalentservices.com) for other accommodation options.
If you have questions about this posting, please contact support@lensa.com
