Clinical Review Nurse

Actalent • Houston, TX • 2h ago

Job Description

Join a dynamic team in a brand new 2026 program dedicated to managing the Duals line of business, combining Medicare and Medicaid benefits into a single comprehensive service. This program operates in eight states and may expand further in 2027. The role involves managing the complexities of both Medicare and Medicaid requirements simultaneously, focusing on inpatient concurrent reviews.

Responsibilities

Conduct clincal reviews, averaging 1.85 cases per hour.

Manage both Medicare and Medicaid requirements effectively.

Utilize InterQual for medical management and decision-making.

Ensure compliance with managed care policies and procedures.

Essential Skills

Registered Nurse (RN) with a compact license.

Experience in Utilization Management (UM).

Proficient in concurrent review and prior authorization.

Strong computer skills and ability to use medical management software.

Familiarity with InterQual guidelines.

Experience in acute care, Medicaid, and Medicare.

Work Environment

The position offers a flexible work environment where you can choose your seating location. Training lasts approximately two weeks, followed by mentorship from a preceptor. Work hours start around 8 or 9 AM, with the ability to work as late as 7 PM, and you must work within your time zone.

Job Type & Location

This is a Contract to Hire position based out of Houston, TX.

Pay and Benefits

The pay range for this position is $34.00 - $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 Mar 17, 2026.

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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