Remote Utilization Management Nurse Reviewer
Posted on: November 23, 2021
The Utilization Management Nurse Reviewer is responsible for
day-to-day timely clinical and service authorization review for
medical necessity and decision-making.
The Utilization Management Nurse Reviewer works with healthcare
providers to ensure appropriate approval of plan benefits. This is
accomplished by reviewing clinical information provided to assess
medical necessity and the appropriateness of the treatment setting
through the application of appropriate policies and criteria (i.e.
Milliman). Case assignments may fall in various areas, such as
concurrent review of inpatient services, discharge planning,
retrospective review, and special needs facilities (SNF), Long Term
Acute Care Facilities (LTAC) and Rehabilitation Facilities.
- Current Active and Unrestricted Nursing License required
(Associate Degree, Nursing Diploma or Bachelor's degree in Nursing)
(If outside of FL, must be compact, multistate RN license.)
- 2-3 years' clinical experience in a managed health care
- 2-3 years' utilization management experience in a managed
healthcare setting (insurance company)
- Must be familiar/comfortable with InterQual
- Required experience in utilization management to include
utilization review, concurrent review, discharge planning, appeals
experience, transitional care and skilled nursing review.
- Must pass typing test with 40+ WPMHours:
Work From Home full-time, equipment and training provided,
6 Month Contract to Hire
- Bachelor's Degree in Nursing preferred with 3-5 years of
clinical experience in Utilization Review
- Knowledge of Medicaid, Commercial or Medicare Managed Care
programs and regulationsAbout Actalent:
Actalent connects passion with purpose. Our scalable talent
solutions and services capabilities drive value and results and
provide the expertise to help our customers achieve more. Every
day, our experts around the globe are making an impact. We're
supporting critical initiatives in engineering and sciences that
advance how companies serve the world. Actalent promotes consultant
care and engagement through experiences that enable continuous
development. Our people are the difference. Actalent is an
operating company of Allegis Group, the global leader in talent
The company is an equal opportunity employer and will consider all
applications without regards to race, sex, age, color, religion,
national origin, veteran status, disability, sexual orientation,
gender identity, genetic information or any characteristic
protected by law.
Keywords: Actalent, Nashville , Remote Utilization Management Nurse Reviewer, Healthcare , Nashville, Tennessee
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