Clinical Review Nurse

Clinical Review Nurse u2013 Concurrent Review Location: Remote u2013 Candidates can be live anywhere in the US but must be able to work CST hours Schedules Available: + Mondayu2013Friday, 10:30 AM u2013 7:00 PM CST + Fridayu2013Monday, 8:00 AM u2013 6:30 PM CST + Wednesdayu2013Saturday, 8:00 AM u2013 6:30 PM CST + Sundayu2013Wednesday, 8:00 AM u2013 6:30 PM CST Position Overview We are seeking Clinical Review Nurses to join our remote team. In this role, you will perform concurrent reviews to evaluate medical necessity, determine appropriate levels of care, and contribute to discharge planning. You will also collaborate with providers and medical directors, document findings, and support the creation of denial correspondence that meets NCQA and state standards. Key Responsibilities + Conduct concurrent reviews to assess member health, care setting, and medical necessity + Review acuity, resource use, length of stay, and discharge planning for quality and continuity of care + Collaborate with Medical Affairs and Medical Directors on care determinations + Document findings, discharge plans, and actions in health management systems + Work with providers to approve or recommend determinations based on review findings + Educate providers on utilization processes to ensure high-quality care + Support denial correspondence creation in clear, member-friendly language + Collaborate with care management teams for referrals and transitions of care Requirements + Graduate from an accredited School of Nursing or BSN with 2u20134 years of related experience + Required Licensure: LPN/LVN or RN u2013 Compact State License + Strong time-management skills and ability to work independently + Experience with electronic medical records (Epic, Trucare, Trucare Cloud preferred) + Knowledge of Medicaid or Medicare regulations and utilization management processes + Proficiency in Microsoft Word, Excel, and EHR systems Must Haves: + Compact Nursing License + Strong time-management and self-motivation + Experience with EMR systems + Medicaid, Medicare or insurance-related knowledge + Prior utilization management experience What We Offer + Fully remote role with national location flexibility (CST schedule required) + Highly engaged team culture with daily collaboration + Work-life balance with structured schedules and rotational holiday coverage Job Type & Location This is a Contract position based out of Austin, TX. Pay and Benefits The pay range for this position is $33.00 - $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: u2022 Medical, dental & vision u2022 Critical Illness, Accident, and Hospital u2022 401(k) Retirement Plan u2013 Pre-tax and Roth post-tax contributions available u2022 Life Insurance (Voluntary Life & AD&D for the employee and dependents) u2022 Short and long-term disability u2022 Health Spending Account (HSA) u2022 Transportation benefits u2022 Employee Assistance Program u2022 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 Dec 16, 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 ( ) for other accommodation options.

Created: 2025-12-05