Medical Review Nurse

Job Description

Join our team as a Utilization Management Specialist, where you will play a pivotal role in reviewing service authorization requests to ensure the utilization of appropriate medical services. Your daily tasks will include reviewing various specialties, medical treatments, home care, and out-of-plan referrals. You will assist with complex cases and contribute to the development of internal processes. Additionally, you will provide education to physicians and team members on utilization review (UR) and appropriate admissions and placements. Managing continuity of care, ensuring safe transitions, patient and provider satisfaction, and appropriate length of stay will also be part of your responsibilities.

Hard Skills

• Knowledge of case management and UR concepts
• Utilization review of prior authorizations for medical necessity
• Familiarity with and ability to apply Milliman and InterQual criteria

Soft Skills

• Team collaboration
• Effective communication
• Process development

Work Site

This is a fully remote position.

Work Environment

This position operates in a fast-paced environment under the supervision of the Medical Director and/or Medical Management supervisor, as part of an interdisciplinary team.

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 : $28 - $35