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Utilization Review RN (Critical Care)

Schedule: Monday–Friday, 8:30 AM–5:00 PM (Rotating weekends)

About the Role

We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our team. In this role, you will ensure appropriate care by conducting precertification and medical necessity reviews for referrals, outpatient procedures, and inpatient admissions. You’ll collaborate with healthcare professionals and administrative teams to support quality care and compliance with established guidelines.

Key Responsibilities

+ Review and approve precertification and medical necessity for designated referrals, procedures, and admissions.

+ Conduct telephonic reviews for targeted services and procedures.

+ Perform retrospective emergency department reviews.

+ Verify eligibility and benefits as needed.

+ Identify patients for case management programs.

+ Participate in quality improvement initiatives.

+ Communicate effectively with care coordinators, case managers, providers, members, and internal teams (claims, benefits, appeals, risk management).

Required Qualifications

+ Active RN license in Georgia or Compact State - must be local to GA and preferably at a commutable distance from Atlanta

+ BSN degree required.

+ Minimum 1 year of utilization review experience.

+ Minimum 1 year of managed care experience.

+ BLS and CPR certifications.

+ Experience with concurrent, prospective, and retrospective reviews.

+ Familiarity with MCG and InterQual standards and guidelines

Preferred Skills & Experience

+ Knowledge of MCG guidelines.

+ Proficiency in EPIC electronic health record system.

+ Previous roles in insurance, inpatient care, and ICU settings.

Job Type & Location

This is a Contract position based out of Atlanta, GA.

Pay and Benefits

The pay range for this position is $45.00 - $60.00/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 onsite position in Atlanta, GA.

Job Type & Location

This is a Contract position based out of Atlanta, GA.

Pay and Benefits

The pay range for this position is $45.00 - $60.00/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 onsite position in Atlanta,GA.

Application Deadline

This position is anticipated to close on Jan 23, 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 [email protected] (%[email protected]) for other accommodation options.