Clinical Review Nurse

Actalent • Orlando, FL • 1d ago

Job Title: Clinical Review NurseJob Description:

The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical necessity for members admitted to the hospital. The primary goal is to advocate for and protect members from unnecessary hospital admissions. This role requires following various procedures and processes to complete authorizations successfully. The nurse will collaborate with a team of nurses and communicate with doctors and case managers to make informed decisions and gather additional information about the member's condition.

Responsibilities:

Review approximately 20 cases a day for medical necessity.

Advocate for and protect members from unnecessary hospital admissions.

Follow established procedures and processes to complete authorizations.

Collaborate with a team of nurses to assist each other and complete cases.

Communicate with doctors and case managers to make decisions and obtain additional information about members' conditions.

Utilize multiple resources to ensure the successful completion of cases.

Essential Skills

Experience in utilization management, concurrent review, prior authorization, utilization review, case management, and discharge planning.

Proficiency with InterQual.

Active Compact RN License, Compact LPN is okay too

Utilization Management/Concurrent Review experience.

ICU/ER experience.

Strong communication skills.

Strong computer/documentation skills.

Work Environment

This is a full remote work-from-home position. The hours are Monday through Friday from 8:00am to 5:00pm. The dress code is business casual.

Pay and Benefits

The pay range for this position is $35.00 - $40.00/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 remote position.

Application Deadline

This position is anticipated to close on Aug 15, 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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