<p>Actalent is hiring a Clinical Review Nurse role!</p> <p>Job Description</p> <p>The Clinical Reviewer is a telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay for Long Term Acute Hospitals, Skilled Nursing Facilities, and Institutional Rehab Facilities through collaboration. This role involves working closely with key facility personnel and internal medical directors to develop and maintain timely discharge plans.</p> <p>Responsibilities</p> <ul> <li>Collaborate with PAC Medical Director to ensure proper medical necessity decisions are being rendered. </li><li>Partner closely with PAC Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes. </li><li>Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives. </li><li>Receive/respond to requests from unlicensed staff regarding scripted clinical questions and issues. </li><li>Act as the primary contact to the post-acute facility to obtain all clinical information required and proactively obtain patient status updates. </li><li>Work alongside the Supervisor and closely with Market Engagement Directors to address potential facility concerns, pushback, or gaps in process efficiently. </li><li>Communicate customer service/provider issues to supervisor for logging and resolution. </li><li>Conduct scheduled telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness for continued stay. </li><li>Authorize continued stay at SNF, IRF, and Home Health Care using approved medical care guidelines and collaboration with key facility personnel. </li><li>Use clinical expertise to review clinical information and criteria to determine if the service/device meets medical necessity for the member. </li><li>Ensure case review and elevation to complete the determination is rendered within contractual and regulatory turnaround time standards. </li><li>Participate in performance and operational improvement activities. </li><li>Contribute to ongoing quality assessment/improvement activities, ensuring the collection of data for improvement analysis and preparing reports as requested. </li><li>Assist team in implementing and maintaining standardized operational processes to ensure compliance with company policies, legal requirements, and regulatory mandates. </li><li>Participate in special projects and perform other duties as assigned. </li><li>Participate in an annual Inter-rater reliability Testing Process. </li></ul> <p>Essential Skills</p> <ul> <li>Excellent negotiation, influencing, problem-solving, and decision-making skills. </li><li>Strong communication (verbal/written), organizational, and interpersonal skills. </li><li>Ability to work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision. </li><li>Strong commitment to quality and standards. </li><li>3 years of concurrent review experience and/or discharge planning. </li><li>2 years of utilization review/management experience. </li></ul> <p>Additional Skills & Qualifications</p> <ul> <li>Current and unrestricted LPN or RN license (TX, GA, FL, KY, NJ, or PA). </li><li>Associate's Degree or Diploma in Nursing/Practical Nursing. </li><li>Minimum 2 years clinical experience in a clinical setting. </li><li>Experienced in Utilization Management and knowledge of URAC & NCQA standards. </li><li>Broad knowledge of healthcare delivery/managed care regulations and experience with evidence-based care guidelines (e.g., MCG/Milliman, Interqual). </li><li>High level clinical knowledge, communication, customer service, and problem-solving skills. </li><li>Ability to effectively interact with all levels of management and a highly diverse clientele. </li><li>Strong organizational skills. </li><li>Strong time management skills. </li><li>Preferred: Case management experience, transition-of-care experience, comfortable speaking with providers/offices via phone, Interqual experience, Milliman/MCG experience. </li></ul> <p>Work Environment</p> <p>This is a fully remote position with equipment provided. The initial 90-day probationary period grants eligibility for up to 40 hours of PTO and 6 paid holidays throughout the 12-month contract. The opportunity exists to go permanent with a large managed care organization. Work schedule: Tuesday to Saturday, 11 AM - 8 PM ET. Training schedule: Monday to Friday, 8 AM - 4:30 PM EST. Post-training contract schedule offers two openings: Sunday to Thursday, 11 AM to 8 PM EST, and Tuesday to Saturday, 11 AM to 8 PM EST. Nurses have the option to work 4 x10s; however, the schedule would be Thursday to Sunday, 9:30 AM to 8 PM.</p> <p>Pay and Benefits</p> <p>The pay range for this position is $32.00 - $39.00/hr.</p> <p>Eligibility requirements apply to some benefits and may depend on your job</p> <p>classification and length of employment. Benefits are subject to change and may be</p> <p>subject to specific elections, plan, or program terms. If eligible, the benefits</p> <p>available for this temporary role may include the following:</p> <ul> <li>Medical, dental & vision </li><li>Critical Illness, Accident, and Hospital </li><li>401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available </li><li>Life Insurance (Voluntary Life & AD&D for the employee and dependents) </li><li>Short and long-term disability </li><li>Health Spending Account (HSA) </li><li>Transportation benefits </li><li>Employee Assistance Program </li><li>Time Off/Leave (PTO, Vacation or Sick Leave) </li></ul> <p>Workplace Type</p> <p>This is a fully remote position.</p> <p>Application Deadline</p> <p>This position is anticipated to close on Jun 27, 2025.</p> <p>About Actalent</p> <p>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.</p> <p>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.</p> <p>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 actalentaccommodation@actalentservices.com for other accommodation options.</p>