What are the responsibilities and job description for the Clinical Review Nurse position at Actalent?
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.
Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Skills:
- Utilization Review
- Acute care
- Prior Authorization
- CCM Certification
- ACLS Certification
- Medicare
Top Skills Details:
- Utilization Review
- Acute care
- Prior Authorization
Additional Skills & Qualifications:
- Registered Nurse, LVN, OR LP
- Prior Authorization/Utilization Review MUST HAVE
- CCM Certification PLUS
- ACLS Certification PLUS
Experience Level:
- Intermediate Level
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.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
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 process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Salary : $35 - $37