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Job Title: Clinical Review Nurse - Concurrent Review
Work Environment
- This is a 100% remote position
- The schedule is Tuesday to Saturday, 10 AM to 7 PM PST.
- Training will be conducted Monday to Friday, 6 AM to 3 PM PST, for a two-week course with no time off and mandatory camera use.
- The assignment duration is undetermined, with the possibility of extension or conversion to a full-time position. Holidays may be worked as needed with prior notice.
MUST HAVE
- Active RN License Required - TX or Compact License.
- 2-4 years of related experience with a minimum of 2 years in acute care.
- Strong time management and attention to detail.
- Ability to work independently and manage time effectively.
- Flexibility to adapt to volume shifts in specific areas.
- Clinical knowledge and ability to determine member's overall health and treatment needs.
- Knowledge of Medicare and Medicaid regulations preferred.
- Understanding of utilization management processes preferred.
- Proficient in clinical review, case management, and concurrent review.
Job Description
The Clinical Review Nurse will perform concurrent reviews to assess the member's overall health, evaluate the type of care being delivered, and determine medical necessity. This role also involves contributing to discharge planning according to established care policies and guidelines. The position requires assisting in evaluating inpatient services to validate the necessity and setting of care. The nurse will be responsible for generating denial letters for concurrent reviews, but no member or provider outreach is required.
Responsibilities
- Conduct concurrent reviews to determine the member's overall health.
- Review the type of care being delivered and assess 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.
- Generate denial letters for concurrent reviews.
- Work with software tools such as TruCare Classic, Excel, Outlook, Word, and OneNote.
Pay and Benefits
The pay range for this position is $35.00 - $42.00/hr.
Requirements
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 Sep 17, 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 actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
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