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Job Title: Clinical Review Nurse

Job Description

As a Clinical Review Nurse, you will perform concurrent reviews to assess members' overall health, review the type of care being delivered, evaluate medical necessity, and contribute to discharge planning following established care policies and guidelines. You will also assist in evaluating inpatient services to ensure the necessity and appropriateness of the care setting.

Responsibilities

+ Conduct concurrent reviews to determine members' overall health status.

+ Evaluate the type of care being delivered and ensure it meets medical necessity.

+ Contribute to discharge planning according to care policies and guidelines.

+ Assist in evaluating inpatient services to validate the necessity and setting of care.

Essential Skills

+ Proficiency in utilization management and utilization review

+ Experience with Interqual and Medicare

+ Expertise in medical, acute care, concurrent review, and prior authorization

+ Knowledge of managed care and patient care

Additional Skills & Qualifications

+ 2-4 years of hospital experience in areas such as ICU, ER, Med-Surge, PACU, etc.

+ Strong multitasking and time management abilities.

+ Quick learner with a go-with-the-flow attitude.

+ Proficient with computers and technology.

+ Bachelor's or associate's degree in nursing.

+ Compact Texas nursing license.

Work Environment

This is a fully remote position with working hours from 10 am to 7 pm CST (11am-8pm EST). The schedule can be either Sunday to Thursday or Tuesday to Saturday. The role offers the flexibility of working from home, and you will be part of a dynamic team committed to delivering high-quality care.

Pay and Benefits

The pay range for this position is $32.00 - $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 Aug 15, 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 [email protected] (%[email protected]) for other accommodation options.