Clinical Review Nurse - Remote

Job Title: Clinical Review Nurse (Remote) Position Summary: We are seeking a detail-oriented and clinically skilled Clinical Review Nurse to join our team in a fully remote role. The Clinical Review Nurse is responsible for conducting medical necessity reviews, evaluating clinical documentation, assessing healthcare services, and ensuring compliance with established clinical guidelines, regulatory requirements, and organizational policies. Key Responsibilities: Perform clinical reviews to determine medical necessity, appropriateness of care, and level of service. Review medical records, provider documentation, treatment plans, and related clinical information. Apply evidence-based guidelines, regulatory standards, and company policies during the review process. Collaborate with physicians, healthcare providers, case managers, and other interdisciplinary teams. Document review findings thoroughly and accurately within designated systems. Identify opportunities to improve quality of care, member outcomes, and cost-effective healthcare delivery. Ensure compliance with federal, state, and accreditation requirements. Participate in audits, quality improvement initiatives, and process enhancements. Maintain productivity, quality, and turnaround-time standards. Stay current on clinical best practices, healthcare regulations, and review criteria. Required Qualifications: Active, unrestricted compact Registered Nurse (RN) license in good standing. Associate's or Bachelor's degree in Nursing. 2+ years of experience in Utilization Management Experience with Medicare, Medicaid, Commercial Health Plans, or Managed Care programs. Knowledge of InterQual, MCG, or other clinical decision-support guidelines. 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 Aug 31, 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.