Utilization Review Nurse

Actively looking to hire multiple RNs to join a growing managed care organization on a Sunday to Thursday OR Tuesday to Saturday basis doing utilization review for PAC patients. This role is looking for a May 20th start date. Interviews are being set up quickly with equipment provided. Apply today if you are looking for a new role in 2024! The time for this role is 10am CST to 7pm CST.

Max Pay for RNs: $39.00 an hour

Duties:

• Telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned and non-assigned post-acute care (PAC) facilities through collaboration.
• Interact with the PAC Medical Director as needed to ensure proper medical necessity decisions are being rendered.
• Partner closely with the PAC Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes.
• Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives. Receive/respond to requests from unlicensed staff regarding scripted clinical questions and issues.
• Act as the primary contact to the post-acute facility or facilities to which they are assigned to obtain all clinical information required and to proactively obtain patient status updates.
• Work alongside the Supervisor, and work closely with Market Engagement Directors to efficiently address potential facility concerns, pushback or gaps in process.
• Communicate customer service/provider issues to supervisor for logging and resolution.

Qualifications:

• Current and unrestricted RN license
• MINIMUM 2 years clinical experience in a clinical setting
• Experienced in Utilization Management and knowledge of URAC & NCQA standards
• Broad knowledge of health care delivery/managed care regulations and experience with evidence based care guidelines (i.e. MCG/Milliman, Interqual).

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.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

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 process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.