Remote Concurrent-Review Nurse | Utilization & Discharge

Actalent; Santa Fe (TX); Remote; USD 52,000 - 58,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) with pre-tax and Roth options

Paid time off (PTO)

Fully remote position

Job summary

Actalent is seeking a Concurrent Review Nurse to conduct concurrent reviews, evaluate medical necessity, and contribute to discharge planning. The role emphasizes collaboration with Medical Affairs, documentation in TruCare systems, and education of providers on utilization processes.

The position is remote and contract-to-hire, based in Texas and supporting Medicare/Medicaid utilization management in various care settings.

Qualifications

• Active RN license in good standing.
• 2–4 years of related experience, including 2+ years in acute care.
• Strong knowledge of Medicare/Medicaid regulations and utilization management.
• Ability to apply clinical criteria to review decisions.
• Experience documenting findings in health management systems.

Responsibilities

• Conduct concurrent reviews to determine the appropriateness of care and setting.
• Review acuity level, resource consumption, length of stay, and discharge planning.
• Collaborate with Medical Affairs/Medical Directors on member care recommendations.
• Document findings, discharge plans, and actions in health management systems.
• Educate providers on utilization processes and criteria.

Skills

RN license

Acute care experience

Utilization management

Clinical assessment

Medicare/Medicaid knowledge

Education

Bachelor's degree in Nursing

Tools

TruCare Classic

TruCare Cloud

InterQual criteria

MCG criteria

Job description

Actalent is seeking a Concurrent Review Nurse to conduct concurrent reviews, evaluate medical necessity, and contribute to discharge planning. The role emphasizes collaboration with Medical Affairs, documentation in TruCare systems, and education of providers on utilization processes.

The position is remote and contract-to-hire, based in Texas and supporting Medicare/Medicaid utilization management in various care settings.