Clinical Review Nurse Inpatient Concurrent Review

Job Title: Registered Nurse - Duals Program Utilization Management 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 inpatient concurrent reviews, averaging 2 reviews per hour. Manage both Medicare and Medicaid requirements effectively. Perform clinical reviews 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 Strong computer skills and ability to use medical management software. Ability to perform real-time (Concurrent) review of inpatient cases Strong understanding of medical necessity guidelines, such as InterQual or MCG Skilled at interpreting clinical documentation and determining appropriate levels of care Experience in acute care, Medicaid, and Medicare Work Environment Training lasts approximately two weeks, followed by mentorship from a preceptor. Work hours start around 9 or 10 AM, with the ability to work as late as 7 PM, and you must work within your time zone. Candidates in Central, Pacific, and Mountain time zones are preferred. Schedule: Tuesday-Saturday OR Sunday- Thursday 8 to 5pm, Mountain time Job Type & Location This is a Contract to Hire position based out of St. Louis, MO. Pay and Benefits The pay range for this position is $34.00 - $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 10, 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.