Clinical Concurrent Review Nurse

Actalent is Hiring a Team of Concurrent Review Nurses (Utilization Management)!! Job Description This role performs concurrent reviews of inpatient acute and post-acute cases to determine medical necessity, evaluate the appropriateness of the level of care, and support safe and timely discharge planning in accordance with established clinical criteria, regulatory requirements, and organizational policies. The nurse collaborates closely with physicians, case managers, social workers, and other healthcare providers to ensure high-quality, efficient, and appropriate care for members while maintaining accurate documentation in utilization management systems. Responsibilities Perform concurrent reviews of inpatient acute and post-acute cases to assess medical necessity, appropriateness of care, and level of care using established clinical criteria such as InterQual or MCG. Evaluate members’ overall health status, treatment plans, acuity level, resource consumption, length of stay, and discharge readiness to determine the appropriate setting and level of care. Review clinical documentation to validate the necessity and setting of care being delivered and to ensure quality and continuity of care. Work with Medical Affairs, Medical Directors, and clinical leadership to discuss complex cases, treatment plans, and medical necessity determinations. Collect, document, and maintain concurrent review findings, authorization decisions, discharge plans, and actions taken in utilization and health management systems according to policies and guidelines. Collaborate with physicians, case managers, social workers, and other healthcare providers to approve medical determinations or provide recommendations based on requested services and review findings. Facilitate appropriate transitions of care by reviewing transfer and discharge plans between facilities and levels of care to support timely and safe discharges. Support care coordination efforts through referrals to care management, case management, and other support services as appropriate. Educate providers on utilization management processes, clinical criteria, documentation requirements, and expectations to promote high-quality, appropriate care. Provide feedback to leadership on opportunities to improve appropriate level of care, medical necessity determinations, and overall utilization management processes based on clinical policies and guidelines. Ensure compliance with Medicare, Medicaid, regulatory, and organizational policies, standards, and utilization management guidelines in all review activities. Identify opportunities to improve quality, efficiency, and appropriate utilization of healthcare services through analysis of review findings and care patterns. Collaborate with care management teams on referral of members who may benefit from additional support or care coordination. Review members’ transfer and discharge plans to promote continuity of care and minimize gaps between levels of care and facilities. Perform other related duties as assigned in support of utilization management and member care. Essential Skills Graduate of an accredited School of Nursing. Bachelor’s degree in Nursing preferred. Active Registered Nurse (RN) license required. Eligibility for or possession of a compact RN license preferred, or willingness to obtain compact licensure. 2+ years of acute care nursing experience required. 2–4 years of utilization management, concurrent review, case management, or related clinical experience preferred. Clinical knowledge and ability to assess overall health status, treatment needs, and appropriate level of care for members. Experience reviewing inpatient acute and post-acute levels of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Familiarity with InterQual, MCG, or other medical necessity guidelines preferred. Knowledge of utilization management processes preferred. Ability to interpret and apply clinical criteria to determine medical necessity and appropriate setting of care. Strong clinical documentation review skills to assess acuity, length of stay, resource utilization, and discharge readiness. Effective communication skills for collaborating with physicians, case managers, social workers, and clinical leadership. Proficiency in documenting review findings, authorization decisions, and discharge planning activities in utilization management systems. Work Environment The role operates in a professional clinical and administrative setting focused on utilization management and concurrent review of inpatient acute and post-acute care. Nurses in this position work extensively with electronic health records, utilization management platforms, and health management systems to document review findings and authorization decisions. The work involves regular collaboration with physicians, case managers, social workers, Medical Directors, and other healthcare professionals, typically during standard business hours, with possible flexibility depending on organizational needs. The environment emphasizes adherence to clinical policies, Medicare and Medicaid regulations, and organizational standards, with a strong focus on quality, efficiency, and appropriate use of healthcare services. Dress is generally professional and appropriate for a clinical or healthcare office setting. Job Type & Location This is a Contract position based out of Phoenix, AZ. Pay and Benefits The pay range for this position is $36.00 - $40.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. 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 Sep 1, 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 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service. 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 [email protected] for other accommodation options. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.