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Clinical Review Nurse – Concurrent Review

Schedule: Tuesday–Friday, 10:00 AM – 9:00 PM CST; overtime as needed; weekends and holidays on a rotation basis

Business Unit: Medicaid

About the Role

We are seeking a Clinical Review Nurse to perform concurrent reviews for Medicaid members, ensuring appropriate care, medical necessity, and discharge planning in alignment with clinical policies and guidelines. This role is fully remote but requires a Compact State Nursing License and the ability to work Central Standard Time hours.

Key Responsibilities

+ Conduct concurrent reviews to determine member health status, appropriate level of care, and medical necessity

+ Review acuity, resource consumption, length of stay, and discharge planning for quality and continuity of care

+ Collaborate with Medical Affairs and Medical Directors on member care decisions

+ Document review findings, discharge plans, and actions in health management systems per utilization management policies

+ Work with providers to approve determinations or provide recommendations based on review findings

+ Educate providers on utilization processes to ensure high-quality care

+ Review transfer and discharge plans to ensure timely transitions between care levels

+ Collaborate with care management teams for member referrals

Requirements

+ Graduate from an accredited School of Nursing or BSN with 2–4 years of related experience

+ Required Licensure: LPN/LVN or RN – Compact State License

+ Strong time-management skills and ability to work independently

+ Experience with electronic medical records (Epic, Trucare, Trucare Cloud preferred)

+ Knowledge of Medicaid regulations and utilization management processes preferred

+ Proficiency in Microsoft Word, Excel, and EHR systems

Must Haves:

+ Compact Nursing License

+ Strong time-management and self-motivation

+ Experience with EMR systems

+ Medicaid or insurance-related knowledge

+ Prior utilization management experience

Disqualifiers:

+ Inability to work weekends or holidays

Job Type & Location

This is a Contract position based out of Austin, TX.

Pay and Benefits

The pay range for this position is $33.00 - $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 Dec 16, 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.