Utilization Review RN - REMOTE

Job Title: Utilization Review - FULLY REMOTE Job Description This role involves performing precertification and medical necessity reviews for designated referrals and targeted outpatient procedures, services, and inpatient admissions. The position requires telephonic reviews to assess medical necessity using established criteria and guidelines, as well as conducting retrospective emergency department reviews. Additional responsibilities include performing eligibility and benefit reviews, identifying patients for case management, conducting quality improvement reviews, and maintaining communication with various healthcare professionals and departments. Responsibilities + Carry out precertification and medical necessity reviews for designated referrals. + Perform telephonic reviews for medical necessity of targeted outpatient procedures, services, and inpatient admissions. + Conduct retrospective emergency department reviews. + Perform eligibility and benefit reviews as necessary. + Identify patients for case management. + Conduct quality improvement reviews. + Communicate with inpatient care coordinators, case managers, SNF/Rehab care coordinators, members, providers, Customer Service, Claims, Contracts and Benefits - Appeals, and Risk Management. Essential Skills + Registered Nurse (RN) with a valid license in GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of experience in managed care. Additional Skills & Qualifications + Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Work Environment The position requires an initial meeting at the regional office for equipment pick-up on the first day in Atlanta, which must be done in person. The role is primarily work-from-home, ideally located within 2 hours of the regional office. There is potential for a hybrid schedule if the position converts to a permanent role, although this has not yet been discussed. Job Type & Location This is a Contract position based out of Atlanta, GA. Pay and Benefits The pay range for this position is $35.00 - $41.00/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 Nov 27, 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 [email protected] (%[email protected]) for other accommodation options.